Comparison of two brief mindfulness interventions for anxiety, stress and burnout in mental health professionals: a randomised crossover trial.

Background: Anxiety, stress and burnout are a growing reality among mental health professionals, impacting negatively on them and their clients. Mindfulness-based interventions (MBIs) have demonstrated effectiveness in mitigating these sufferings. Nevertheless, there is a lack of knowledge on the impact of MBIs in Cuba. Objectives: To compare the effectiveness of two brief mindfulness-based interventions for reducing anxiety, work stress and burnout. Methods: A total of 104 mental health professionals from Havana (Cuba) participated in a randomised crossover trial. Group A received first an intervention involving body-centred practices (body scan and Hatha yoga) and a second intervention involving mind-centred practices (focused attention and open monitoring meditation). Group B received the same interventions but in reverse order. Four measures (anxiety, stress, burnout syndrome, and antecedents of burnout) were measured at baseline, posttest1, posttest2, and 6-months follow-up. Results: After the first intervention, there was a between-group difference for burnout syndrome, but the ES was similar for both groups. After the second intervention (implementing both practises), groups showed the largest effect sizes, and there was a between-group difference for antecedents of burnout. Results were partially maintained at 6-month follow-up. Conclusion: These results suggest that mind-centred practises can be as effective as body-centred practises for stress, anxiety and burnout reduction. The combination of both types of practises could be the most effective way of teaching mindfulness. About the sequence of implementation, teaching mind-centred practises first and then body-centred practises could be most effective for reducing antecedents of burnout.Clinical Trial Registration: www.clinicaltrials.gov NCT03296254.

Persons with Substance Abuse Disorders and Other Addictions: Coping with the COVID-19 Pandemic.

Cuba implemented policies mandating social distancing on March 11, 2020, which were still in place at the time of this study. During such periods of isolation, people with psychoactive substance-related disorders and other addictions may be tempted to reduce tension, stress, uncertainty and possible distress by increasing the use of substances or practices they have abused. This can mean relapses and setbacks for patients undergoing treatment. A multidisciplinary team of health professionals specializing in addiction at the Center for Academic Development in Drug Addiction, in Havana, Cuba, cares for people with these disorders and followed their evolution during the initial period of COVID-19 social isolation. With the aim of characterizing strategies employed by patients undergoing treatment for substance abuse and addictions, we conducted a qualitative study from April 2020 through May 2020, using a convenience sample of 37 patients (all students) who had been progressing towards recovery from addictive behaviors when face-to-face encounters were suspended due to COVID-19 restrictions. Contact was maintained through information and communication technologies. The research used telepsychology and focused on understanding patient life experiences. Patients were interviewed using a semi-structured survey, which was then transcribed and coded thematically using a grounded-theory approach. We found that patients' ability to cope successfully with challenges presented by COVID-19 were influenced by: 1) the individual's own methods for maintaining self-control (commitment to studies, projects, and work with therapists) that aided them in their goals concerning abstinence; 2) difficulties faced in addressing specific events and situations (doubts, uncertainties, disagreements, isolation and time use); 3) perpetuation and revivification of myths related to substances and addictive activities (exacerbation of supposed benefits of tobacco, alcohol, marijuana, overuse of social networks); and 4) tendencies toward irrationality and lack of emotional control (fear, sadness, anger, constant worry and self-imposed demands). Our findings suggest that despite the potential negative psychological impact of preventive social isolation during the COVID-19 pandemic, individual coping mechanisms developed by these patients, aiming at improved self-control, allowed most to avoid setbacks that could have affected their recovery. Nevertheless, patients faced challenges to their recovery that were compounded by difficulties in specific situations, myths related to substances and addictive activities, and tendencies toward irrationality or lack of emotional control.

Contralateral sensorineural hearing loss after vestibular schwannoma surgery / Hipoacusia neurosensorial contralateral tras cirugía de schwannoma vestibular

Introduction: Contralateral sensorineural hearing loss (CSNHL) after vestibular schwannoma (VS) is a severe complication, especially in those cases in which hearing preservation in the operated side was not possible. There are several theories that attempt to explain this issue, but there is no established guideline of treatment. Material and methods: We report 4 patients treated in our institution who developed a severe CSNHL after surgery. Results: Of the 185 cases of VS treated with surgery, 4 patients (2.2%) developed a CSNHL after VS surgery. After medical treatment, partial recovery of hearing occurred in one patient the other 3 patients presented a well-established severe SNHL. Conclusions: Established treatment guidelines do not exist, but the use of high doses of corticosteroids has been recommended and cochlear implant in cases with no recovery and complete hearing loss may be useful

Introducción: La hipoacusia neurosensorial contralateral (HNSC) tras cirugía de schwannoma vestibular (SV) es una complicación grave, especialmente en aquellos casos en los que la preservación de la audición del lado intervenido no fue posible. Existen varias teorías que intentan explicar este problema, pero no existe una guía de tratamiento en estos casos. Material y métodos: Presentamos los casos de 4 pacientes tratados en nuestro hospital que desarrollaron una HNSC severa tras cirugía de SV. Resultados: De los 185 casos de SV tratados con cirugía, 4 pacientes (2,2%) desarrollaron una HNSC después de la cirugía. Tras el tratamiento médico se produjo recuperación parcial de la audición en un paciente, los otros 3 pacientes presentaron una HNS severa. Conclusiones: No existen guías de tratamiento, pero se recomienda el uso de altas dosis de corticosteroides y el implante coclear en casos sin recuperación y pérdida completa de la audición

Contralateral sensorineural hearing loss after vestibular schwannoma surgery.

INTRODUCTION: Contralateral sensorineural hearing loss (CSNHL) after vestibular schwannoma (VS) is a severe complication, especially in those cases in which hearing preservation in the operated side was not possible. There are several theories that attempt to explain this issue, but there is no established guideline of treatment. MATERIAL AND METHODS: We report 4 patients treated in our institution who developed a severe CSNHL after surgery. RESULTS: Of the 185 cases of VS treated with surgery, 4 patients (2.2%) developed a CSNHL after VS surgery. After medical treatment, partial recovery of hearing occurred in one patient the other 3 patients presented a well-established severe SNHL. CONCLUSIONS: Established treatment guidelines do not exist, but the use of high doses of corticosteroids has been recommended and cochlear implant in cases with no recovery and complete hearing loss may be useful.

Mitochondrial Trifunctional Protein Deficiency: Severe Cardiomyopathy and Cardiac Transplantation.

We describe mitochondrial trifunctional protein deficiency (MTPD) in two male siblings who presented with severe cardiomyopathy in infancy. The first sibling presented in severe cardiac failure at 6 months of age and succumbed soon after. The second sibling came to attention after newborn screening identified a possible fatty acid oxidation defect. Dietary therapy and carnitine supplementation commenced in the neonatal period. Despite this the second child required cardiac transplantation at 3 years of age after a sudden and rapid decline in cardiac function. The outcome has been excellent, with no apparent extra-cardiac manifestations of a fatty acid oxidation disorder at the age of 7. Pathogenic HADHA mutations were subsequently identified via genome wide exome sequencing. This is the first reported case of MTPD to undergo cardiac transplantation. We suggest that cardiac transplantation could be considered in the treatment of cardiomyopathy in MTPD.

Complicación que se presenta en los pacientes al tratamiento con heberprot-p en un área de salud / Complication that occurs in patients to heberprot-p treatment in a health area

Introducción: la diabetes es considerada una epidemia en el mundo. El pie diabético constituye un serio problema de salud en Cuba. El heberprot-p es un novedoso medicamento que puede solucionar una necesidad médica no cubierta a nivel mundial. Objetivo: determinar la complicación que se presentó durante la terapia con heberprot-p. Método: se realizó en el Policlínico Manuel Piti Fajardo de Santo Domingo entre enero de 2012 y diciembre de 2015 un estudio descriptivo de corte longitudinal a los 108 pacientes tratados con heberprot-p, la muestra estuvo conformada por los 14 que tuvieron una evolución no satisfactoria. La información se obtuvo por el método de encuesta y a través de la revisión de las historias clínicas y de las tarjetas de registro de tratamiento. Resultados: de la población estudio el 87 por ciento de los pacientes que llevaron tratamiento con heberprot-p tuvieron una evolución satisfactoria; de los pacientes con evolución no satisfactoria la principal complicación fue la infección local (100 por ciento); el 64,3 por ciento eran del sexo masculino y el 78,6 por ciento tenía edad mayor de 60 años, el 64,3 por ciento tenían más de 10 años de evolución de la diabetes y los factores de riesgo de mayor prevalencia fueron la hiperglucemia, el sobrepeso y la obesidad (o ambos), seguidos de la dislipidemia y la depresión, respectivamente. Conclusiones: se determinó que la infección local fue la complicación más frecuente y la hiperglucemia el principal factor de riesgo(AU)

COXPD9 an Evolving Multisystem Disease; Congenital Lactic Acidosis, Sensorineural Hearing Loss, Hypertrophic Cardiomyopathy, Cirrhosis and Interstitial Nephritis.

We present the second report of combined oxidative phosphorylation deficiency-9. The infant presented in the neonatal period with poor feeding, lactic acidosis and sensorineural hearing loss. He subsequently developed a lethal hypertrophic cardiomyopathy during infancy. Cirrhosis and interstitial nephritis were identified at autopsy. Exome sequencing has detected compound heterozygous mutations in the MRPL3 gene which encodes a large mitochondrial ribosome subunit protein. We identified a known heterozygous variant NM_007208 c.950>G (Pro317Arg) in the MRPL3 gene and a novel heterozygous mutation NM_007208 c.49delC p.(Arg17Aspfs*57). Mutations in MRPL3 have previously been shown to alter ribosome assembly and cause abnormal function of multiple respiratory chain complexes. Our case adds to the evolving knowledge of disorders of mitochondrial translation.

An Intersectoral Intervention to Prevent Early Alcohol Use in Cuban Adolescents.

To encourage development of negative attitudes toward alcohol use and thus prevent early onset of alcohol use, an intersectoral intervention was conducted from 2014 to 2015 among Cuban adolescents in 14 schools in Havana. The intervention included 312 students (189 girls and 123 boys) aged 14 to 15 years in 10th grade of high school or vocational school. Workshops were conducted using participatory techniques and group dynamics. Qualitative methods were applied, including narrative, desiderative and projective techniques. Indicators included attitudes, motivation, interests and perception of risk. Following the intervention, 82.7% (258/312) of participants reported healthy cultural and recreational interests and 61.9% (193/312) reinforced negative attitudes toward drinking. Such interventions can help prevent early onset of alcohol use in school settings. Given the positive results, the intervention is slated to be reproduced in other Cuban provinces. KEYWORDS Adolescents, prevention, alcoholism, attitudes, Cuba.

Formación de actitudes de rechazo al alcohol en adolescentes preuniversitarios / Formation of negative attitudes to alcohol in pre-university teens

Introducción: En este trabajo se expone la valoración de seis años de alianza estratégica entre el Centro de Desarrollo Académico en Drogodependencias de la Universidad de Ciencias Médicas de La Habana y la Empresa Havana Club Internacional. Objetivo: Destacar la especial relevancia de la intersectorialidad en el enfrentamiento a la problemática social que constituye el consumo indebido de alcohol por adolescentes y jóvenes. Desarrollo: La política de Responsabilidad Social Corporativa desarrollada por esta empresa potenció los resultados satisfactorios de las estrategias desarrolladas, las cuales se propusieron reforzar el respeto a las normas de responsabilidad ante el consumo de alcohol por parte de los adultos y la formación de actitudes de rechazo a dicha práctica en niños y adolescentes. Se incluyen referencias a los consensos internacionales promovidos por las principales empresas del sector de la cerveza, el vino y las bebidas espirituosas y se particulariza en el modelo de Responsabilidad Social Corporativa sustentado por Havana Club Internacional. Conclusiones: Se obtuvieron resultados satisfactorios en el trabajo preventivo con adolescentes lográndose retardar el inicio del consumo sistemático de alcohol en la mayoría de los sujetos estudiados y el Proyecto Extensionista Tú decides ha logrado reconocimientos nacionales e internacionales considerándose como ejemplo de buenas prácticas en Intersectorialidad y Responsabilidad Social Corporativa(AU)

Introduction: This paper describes the assessment of six years of strategic partnership between the Center for Academic Development in Drug Addiction University of Medical Sciences of Havana and Havana Club International Company is exposed. Objective: To emphasize the special relevance of intersectoriality in confronting social problems constitutes misuse of alcohol by adolescents and youth. Development: The Politics of Corporate Social Responsibility developed by the company boosted the satisfactory results of the developed strategies, which were proposed to strengthen respect for the rules of responsibility for the consumption of alcohol by adults and the formation of attitudes of rejection such a practice in children and adolescents. references to international consensus promoted by the major companies in the beer industry, wine and spirits and is particularized in the Corporate Social Responsibility model supported by Havana Club International are included. Conclusions: Satisfactory results were obtained in preventive work with adolescents achieving delay the start of systematic alcohol consumption in most of the subjects studied and Thou Extension Project decide has achieved national and international recognition considered as an example of good practice in Intersectoriality and Accountability Corporate social(AU)

The Australia and New Zealand Fontan Registry: description and initial results from the first population-based Fontan registry.

BACKGROUND: The Fontan procedure is the final in a series of staged palliations for single-ventricle congenital heart disease, which encompasses rare and heterogeneous cardiac lesions. It represents an unusual and novel physiological state characterised by absence of a subpulmonary ventricle. AIMS: The population is growing steadily, prompting creation of this registry to study their epidemiology, demographic trends, treatment and outcomes. METHODS: This multicentre, binational, prospective and retrospective, web-based registry involving all congenital cardiac centres in the region has identified nearly all Fontan patients in Australia and New Zealand. Patients identified retrospectively were approached for recruitment. New recipients are automatically enrolled prospectively unless they choose to opt-out. Follow-up data are collected yearly. RESULTS: Baseline data were obtained in 1072 patients as at 1 January 2011. Ninety-nine patients died; 64 were lost to follow up. Forty-four per cent of patients lost were between 20 and 30 years of age. The size of the Fontan population is increasing steadily. Among 973 living patients, 541 (56%) gave consent for prospective collection of follow up. Between 1 January 2011 and 1 January 2013, an additional 47 subjects were enrolled prospectively. The current proportion of patients operated with hypoplastic left heart syndrome is currently 29% and is growing rapidly. CONCLUSION: The population surviving after the Fontan procedure has been growing in recent decades, especially since survival with hypoplastic left heart syndrome has improved. The Australia and New Zealand Fontan Registry provides population-based data, and only large databases like this will give opportunities for understanding the population and performing prospective trials.

Tobacco and alcohol consumption among health sciences students in Cuba and Mexico.

INTRODUCTION: Smoking and alcohol use (beyond social norms) by health sciences students are behaviors contradictory to the social function they will perform as health promoters in their eventual professions. OBJECTIVES: Identify prevalence of tobacco and alcohol use in health sciences students in Mexico and Cuba, in order to support educational interventions to promote healthy lifestyles and development of professional competencies to help reduce the harmful impact of these legal drugs in both countries. METHODS: A descriptive cross-sectional study was conducted using quantitative and qualitative techniques. Data were collected from health sciences students on a voluntary basis in both countries using the same anonymous self-administered questionnaire, followed by an in-depth interview. RESULTS: Prevalence of tobacco use was 56.4% among Mexican students and 37% among Cuban. It was higher among men in both cases, but substantial levels were observed in women as well. The majority of both groups were regularly exposed to environmental tobacco smoke. Prevalence of alcohol use was 76.9% in Mexican students, among whom 44.4% were classified as at-risk users. Prevalence of alcohol use in Cuban students was 74.1%, with 3.7% classified as at risk. CONCLUSIONS: The high prevalence of tobacco and alcohol use in these health sciences students is cause for concern, with consequences not only for their individual health, but also for their professional effectiveness in helping reduce these drugs' impact in both countries.

Schwannoma laríngeo. Un tumor de laringe poco común / Schwannoma of the larynx. An infrequent laryngeal tumour

Los schwannomas laríngeos son tumores benignos infrecuentes, localizados generalmente en la región supraglótica. Suelen originarse a partir de la rama interna del nervio laríngeo superior. La mayoría de los pacientes presentan sensación de globo faríngeo, disfagia o disfonía. La cirugía conservadora es el tratamiento de elección. Se presenta un caso de un schwannoma de laringe asintomático, el cual es diagnosticado incidentalmente en una prueba de imagen. La extirpación completa de la lesión se realizó a través de un abordaje endoscópico transoral con láser CO2 sin requerir la realización de una traqueotomía. Revisamos los procedimientos diagnósticos, el diagnóstico diferencial y las opciones terapéuticas de esta infrecuente entidad (AU)

Schwannomas are benign tumours, rare among tumours of the larynx. They normally present as supraglottic masses (because they may arise from the internal branch of the superior laryngeal nerve), most commonly involving aryepiglottic folds or false vocal folds. Most patients present with a globus sensation, dysphagia or hoarseness. Conservative surgery is the treatment of choice. We report a case of a laryngeal asymptomatic neuroma that was diagnosed accidentally in an imaging test. Complete excision of the tumour was performed through a transoral CO2 laser microsurgery without resorting to a tracheotomy. We discuss the clinical, pathologic and imaging findings and the management of this neoplasm. We also try to update the knowledge on the management of these tumours (AU)

Síndrome de Grisel como secuela de una mastoiditis aguda complicada / Grisel’s syndrome as a sequela of a complicated acute mastoiditis

El síndrome de Grisel es una complicación infrecuente de las infecciones que afectan al área otorrinolaringológica. Consiste en una subluxación atloaxoidea no traumática, tras un proceso infeccioso. Su síntoma característico es la tortícolis, dolorosa y persistente, a pesar de haber solucionado la infección. El conocimiento de esta afección ayuda al diagnóstico y tratamiento precoz de la misma. Queremos, por lo tanto, presentar el caso de un paciente con un síndrome de Grisel como secuela de una mastoiditis aguda complicada con un absceso de Bezold, a fin de favorecer el conocimiento de este tipo de proceso (AU)

Grisel's syndrome is a rare complication of ENT area infections. It consists of a non-traumatic atlantoaxial subluxation after an infectious process. Its characteristic symptom is persistent torticollis despite a resolved infection. The knowledge of this condition helps early diagnosis and treatment. We therefore present the case of a patient with Grisel's syndrome as a sequela of an acute mastoiditis complicated by a Bezold's abscess (AU)

Grisel's syndrome as a sequela of a complicated acute mastoiditis.

Grisel's syndrome is a rare complication of ENT area infections. It consists of a non-traumatic atlantoaxial subluxation after an infectious process. Its characteristic symptom is persistent torticollis despite a resolved infection. The knowledge of this condition helps early diagnosis and treatment. We therefore present the case of a patient with Grisel's syndrome as a sequela of an acute mastoiditis complicated by a Bezold's abscess.

Schwannoma of the larynx. An infrequent laryngeal tumour.

Schwannomas are benign tumours, rare among tumours of the larynx. They normally present as supraglottic masses (because they may arise from the internal branch of the superior laryngeal nerve), most commonly involving aryepiglottic folds or false vocal folds. Most patients present with a globus sensation, dysphagia or hoarseness. Conservative surgery is the treatment of choice. We report a case of a laryngeal asymptomatic neuroma that was diagnosed accidentally in an imaging test. Complete excision of the tumour was performed through a transoral CO2 laser microsurgery without resorting to a tracheotomy. We discuss the clinical, pathologic and imaging findings and the management of this neoplasm. We also try to update the knowledge on the management of these tumours.

Agenesia unilateral de arteria carótida interna / Unilateral agenesis of the internal carotid artery

La agenesia de la arteria carótida interna (ACI) es una entidad infrecuente. Suele ser diagnosticada de forma casual en pacientes sometidos a una exploración radiológica por otro motivo. El diagnóstico de esta anomalía es importante ya que puede asociarse a otras malformaciones potencialmente graves, y debe ser tenido en cuenta si se va a realizar una cirugía sobre el eje carotídeo del lado sano. Presentamos el caso de un varón de 64 años en el que se objetivó incidentalmente una agenesia de ACI izquierda (AU)

Unilateral agenesis of the internal carotid artery (ICA) is an extremely rare anomaly. Diagnosis is often incidental in a radiological examination. Recognition of this anomaly has important clinical implications because other life-threatening conditions can be associated and it must be taken into account when planning carotid surgery. We report a case of 64-year-old man with agenesis of the ICA (AU)

Unilateral agenesis of the internal carotid artery.

Unilateral agenesis of the internal carotid artery (ICA) is an extremely rare anomaly. Diagnosis is often incidental in a radiological examination. Recognition of this anomaly has important clinical implications because other life-threatening conditions can be associated and it must be taken into account when planning carotid surgery. We report a case of 64-year-old man with agenesis of the ICA.

La aceptación de la enfermedad y la adhesión al tratamiento en pacientes con epilepsia

En la consulta especializada de epilepsia del Hospital Psiquiátrico de la Habana se identificaron dificultades para lograr adhesión al tratamiento en pacientes con diagnóstico clínico de epilepsia. Los pacientes no aceptan la enfermedad que padecen, se agotan del carácter continuo del tratamiento y no están dispuestos a asumir los ajustes que demanda su estilo de vida

La aceptación de la enfermedad y la adhesión al tratamiento en pacientes con epilepsia / The acceptance of disease and the treatment adherence in the patient with epilepsy

En la consulta especializada de epilepsia del Hospital Psiquiátrico de la Habana se identificaron dificultades para lograr adhesión al tratamiento en pacientes con diagnóstico clínico de epilepsia. Los pacientes no aceptan la enfermedad que padecen, se agotan del carácter continuo del tratamiento y no están dispuestos a asumir los ajustes que demanda su estilo de vida. Objetivo Evaluar la efectividad de una estrategia psicoterapéutica y educativa dirigida a potenciar la aceptación de la enfermedad y a mejorar el nivel de adhesión terapéutica. Métodos La citada estrategia incluyó sesiones dirigidas a promover el desarrollo de una actitud responsable ante la enfermedad y a la asimilación de las limitaciones que impone. Incluyó recursos racionales, vivenciales y educativos para reforzar la aceptación de la enfermedad y la adhesión terapéutica. La tarea básica inicial fue identificar y modificar la tendencia a ocultar ante los demás y ante sí mismo que padecen de epilepsia. Resultados El nivel promedio obtenido en la escala de adaptación a la medicación y al tratamiento mejoró a partir de la intervención desarrollada. De un puntaje medio de 2,23 que sugiere la presencia de problemas en la adaptación psicosocial a la medicación se pasó a un puntaje medio 1,09 que expresa la ausencia de problemas significativos en esta área. Conclusiones La estrategia psicoterapéutica y educativa dirigida a potenciar la aceptación de la enfermedad y a mejorar el nivel de adhesión terapéutica es efectiva(AU)

Introduction The specialized medical service for epilepsy in the psychiatric hospital of Havana identified several difficulties to succeed in making the patient diagnosed with epilepsy follow the corresponding treatment. The patients do not accept their disease; they get tired of the continued therapy, and refuse to make the necessary arrangements in their lifestyle. Objectives To evaluate the effectiveness of the application of a psychotherapeutic and educational strategy aimed at encouraging acceptance of disease and improving treatment adherence. Methods This strategy included sessions to develop responsible attitude toward the disease and to accept the restrictions that it imposes upon the patient . It also covered rational, affective and educational resources. The initial basic therapeutic task was to identify and to change the tendency of the patient to hide his/her epilepsy from himself/herself and from the others. Results The average scoring in the medication and treatment adherence scale improved after this intervention. From an average score of 2,23, indicating problems in psychosocial adaptation to medication, to 1,09 expressing lack of significant problems in this area. Conclusions The psychotherapeutic and education strategy to encourage the acceptance of disease by the patient and to improve treatment adherence was effective indeed(AU)

La aceptación de la enfermedad y la adhesión al tratamiento en pacientes con epilepsia / The acceptance of disease and the treatment adherence in the patient with epilepsy

En la consulta especializada de epilepsia del Hospital Psiquiátrico de la Habana se identificaron dificultades para lograr adhesión al tratamiento en pacientes con diagnóstico clínico de epilepsia. Los pacientes no aceptan la enfermedad que padecen, se agotan del carácter continuo del tratamiento y no están dispuestos a asumir los ajustes que demanda su estilo de vida. Objetivo Evaluar la efectividad de una estrategia psicoterapéutica y educativa dirigida a potenciar la aceptación de la enfermedad y a mejorar el nivel de adhesión terapéutica. Métodos La citada estrategia incluyó sesiones dirigidas a promover el desarrollo de una actitud responsable ante la enfermedad y a la asimilación de las limitaciones que impone. Incluyó recursos racionales, vivenciales y educativos para reforzar la aceptación de la enfermedad y la adhesión terapéutica. La tarea básica inicial fue identificar y modificar la tendencia a ocultar ante los demás y ante sí mismo que padecen de epilepsia. Resultados El nivel promedio obtenido en la escala de adaptación a la medicación y al tratamiento mejoró a partir de la intervención desarrollada. De un puntaje medio de 2,23 que sugiere la presencia de problemas en la adaptación psicosocial a la medicación se pasó a un puntaje medio 1,09 que expresa la ausencia de problemas significativos en esta área. Conclusiones La estrategia psicoterapéutica y educativa dirigida a potenciar la aceptación de la enfermedad y a mejorar el nivel de adhesión terapéutica es efectiva

Introduction The specialized medical service for epilepsy in the psychiatric hospital of Havana identified several difficulties to succeed in making the patient diagnosed with epilepsy follow the corresponding treatment. The patients do not accept their disease; they get tired of the continued therapy, and refuse to make the necessary arrangements in their lifestyle. Objectives To evaluate the effectiveness of the application of a psychotherapeutic and educational strategy aimed at encouraging acceptance of disease and improving treatment adherence. Methods This strategy included sessions to develop responsible attitude toward the disease and to accept the restrictions that it imposes upon the patient . It also covered rational, affective and educational resources. The initial basic therapeutic task was to identify and to change the tendency of the patient to hide his/her epilepsy from himself/herself and from the others. Results The average scoring in the medication and treatment adherence scale improved after this intervention. From an average score of 2,23, indicating problems in psychosocial adaptation to medication, to 1,09 expressing lack of significant problems in this area. Conclusions The psychotherapeutic and education strategy to encourage the acceptance of disease by the patient and to improve treatment adherence was effective indeed