RESUMO
Mental health problems, specifically mental disorders, develop from a complex system and not from a single cause. Obsessive-compulsive disorder (OCD) affects more than 2% of the population and generally the course of the illness is insidious and chronic. When functioning adequately, family constitutes a very important resource to face health problems and to help to improve the patient's life quality. This is the reason why it is important to underline the relevance of a stable, good functioning of the family system aimed at attaining an optimal development of all its members. Such development may be hindered by the family's incapability to modify functioning patterns at crucial moments when they are trapped in a series of inadaptable interactions which prevent to give specific solutions to the problems that are appearing, and when reporting, within a context of expressed emotion, an emotional over-involvement and high levels of hostility and criticism towards the member with OCD. Family accommodation is a phenomenon typical of families where the identified patient exerts a control based on aggressiveness when his/her wishes are not rewarded within the group. There are very few researches on the functioning of families of patients diagnosed with obsessive-compulsive disorder. Generally, these researches are related with the partially negative effects that the interactions have on the behavior of patients and their relatives by preventing or hindering the development of the subject's system. The accordance between the patient's emotional regulation or emotional intelligence and their relatives has not been studied. On the other hand, the knowledge of the beliefs that relatives hold regarding the illness may be related with the functioning of the group as a family, whereas beliefs will provide consistency to family life because they provide continuity between past, present and future. They are also a way to address new and ambiguous situations such as mental illness. This is the reason why getting to know these family systems may allow elaborating more specific and effective intervention programs for groups and families. Objective To determine the family types through a member identified with obsessive-compulsive disorder; to compare the emotional intelligence profile between patients and relatives according to the perceived type of family; to compare the relatives' beliefs toward the illness according to the perceived type of family. Material and methods A sample of patients and their families with obsessive-compulsive disorder was obtained from those who were sent by the doctor in charge of their treatment to participate in a model of group therapy for OCD, consisting of cognitive behavioral theory, practices and psychoeducation. During the first session patients and their relatives answered the following instruments: Family Adjustment and Cohesion scales (FACES-II) by Olson, Profile of Emotional Intelligence (PIEMO) by Cortés et al., Beck Inventory of Anxiety. Relatives answered too the Beliefs and Attributions Questionnaire by Salorio et al. In addition, data on family structure was complied. The sample was constituted by 48 patients and 61 relatives. All instruments were self-applied. Once that the type was obtained according to the Olson's circumflex model, the emotional profile, the anxious and the depressive symptoms were compared through factorial 2x3 ANOVA. Beliefs and attributions were compared through simple ANOVA. Results Three types of families were determined as follows: high cohesion with chaotic standards for expressing emotions and ideas; high cohesion with a rigid expression of ideas and emotions; low cohesion with a little expression of ideas and emotions. Different profiles of emotional intelligence were found not only for patients but also for relatives, in each family type. Families with high cohesion and high adjustment appear as most emotionally intelligent, less anxious and depressed, and with beliefs more attuned to reality. This type of family function was the less frequent. For beliefs and illness attributions, it was observed that comprehension of the disorder increases in proportion to a higher family adaptation, while the tendency of family members to experience feelings of guilt either towards themselves or towards the patient is decreased. As a result, the perception of experiencing the patient's illness as a nuisance disappears. With regard to the results of the Beck scales, family members perceived a high cohesion and low adaptation had higher scores for depression and anxiety. In patients who show high levels of depression and anxiety perceive family functioning as a rigid structure, with little prospect of change and interaction that prevents growth (high cohesion, low adaptation), and in those perceived isolation, without significant emotional ties with other family members and with the rigidity that prevents problem situations. Conclusions The results obtained are congruent with Olson's statements in regard to family functioning in the specific case of obsessive- compulsive disorder; these findings permit to understand the family dynamics which may typify the symptoms in the identified patients, and also to explain the adjustment situation described in literature. Family intervention is justified, stressing the handling of emotions as an important element to be considered in order to obtain higher therapeutic benefits for the patient. This study found differences in adjustment between patients and their families, do not perceive the need for flexibility in the operation of the system to find solutions that do not perpetuate and sustain interactions that reinforce symptoms. As for depression and anxiety, similar levels in either condition may be observed, thus confirming the close relationship between both. It was found that in patients and relatives, higher levels of family adaptation correspond to lower levels of depressive and anxious symptoms. One of the first approaches to the dynamics of these systems must be headed towards the family systems of beliefs, as the ideas that family members hold regarding the importance of their participation in the whole process of the illness has an impact in its course. Many families have rigid systems that make them more vulnerable to the fluctuations that this illness presents since for their members it is important and decisive to have control over the ailment. Families with flexible systems of beliefs are more prone to experience losses with a feeling of acceptance and therefore it is easier for them to let their members to implement changes in their functioning, thus compensating and overcoming their limitations. In this sense it is important to attain a therapeutic collaboration relationship that may create within the family a sense of realistic control and may help also to put into action the system's capabilities to promote improvement. This idea allows for openness in the system that may lead it to consider that there are more efficient operational measures that those applied to date.
Los problemas de salud mental y específicamente los trastornos mentales se desarrollan a partir de un complejo sistema biopsicosocial y difícilmente se puede identificar una causa única. El trastorno obsesivo compulsivo (TOC) afecta a más de 2% de la población y en general el curso de la enfermedad es insidioso y crónico. La familia es un importante recurso para enfrentar los problemas de salud y facilitar el mejoramiento de la calidad de vida del paciente, cuando su funcionamiento es adecuado. Existen pocas investigaciones realizadas sobre el funcionamiento de las familias de pacientes diagnosticados con trastorno obsesivo-compulsivo. Generalmente estas investigaciones están relacionadas con los efectos potencialmente negativos que dichas interacciones tienen en las conductas de pacientes y familiares que impiden u obstaculizan el desarrollo del sistema y de los individuos. La concordancia de la regulación emocional o inteligencia emocional de los pacientes y sus familiares no ha sido estudiada. Por otra parte el conocimiento de las creencias sobre la enfermedad por parte de los familiares puede estar relacionado con el funcionamiento del grupo como familia. Es por ello que el conocimiento de estos sistemas familiares podrá permitir estructurar programas de intervención grupal o familiar más específicos y eficaces. Objetivo Determinar la tipología de las familias con un miembro identificado con trastorno obsesivo compulsivo, comparando tres aspectos: 1) El perfil de inteligencia emocional entre pacientes y familiares según el tipo de familia percibido. 2) La ansiedad y depresión entre pacientes y familiares según el tipo de familia percibido y 3) Las creencias de los familiares hacia la enfermedad según el tipo de familia percibido. Material y métodos Se obtuvo una muestra de pacientes y sus familiares con trastorno obsesivo compulsivo (TOC) los que fueron enviados por su médico tratante a participar en el modelo terapéutico grupal para TOC, que consiste en Teoría y Técnicas cognitivo conductuales y psicoeducativas. Durante la primera sesión los pacientes y sus familiares acompañantes contestaron los siguientes instrumentos: Escala de cohesión y adaptación familiar (FACES-II) de Olson et al., Perfil de Inteligencia Emocional (PIEMO 2000) de Cortés et al., Inventario de Ansiedad de Beck, Inventario de depresión de Beck. Los familiares contestaron además el Cuestionario de Creencias y Atribuciones sobre la enfermedad de Salorio et al. Además se recabaron datos sobre la estructura familiar. La muestra se conformó por 48 pacientes y 61 familiares. Todos los instrumentos fueron autoaplicados. Una vez obtenida la tipología según el modelo circumplejo de Olson se compararon el perfil emocional y los síntomas ansiosos y depresivos por medio de ANOVA factorial 2x3. Las creencias y atribuciones se compararon por medio de ANOVA simple. Resultados Se determinaron tres tipos de familia: 1. Las de alta cohesión con lineamientos caóticos para la expresión de emociones e ideas. 2. Las de alta cohesión con rigidez en la expresión de ideas y emociones y 3. Las de baja cohesión con escasa expresión de ideas y emociones. Se encontraron perfiles de inteligencia emocional diferentes tanto para pacientes como para familiares en cada uno de los tipos de familia. Las familias con alta cohesión y adaptación se manifiestan como las más inteligentes emocionalmente, menos ansiosas y deprimidas y con creencias más apegadas a la realidad. Sin embargo, este grupo fue el menos frecuente. Conclusiones Los resultados obtenidos son coherentes con los planteamientos de Olson en relación al funcionamiento de las familias. En el caso específico del trastorno obsesivo-compulsivo estos hallazgos permiten entender la dinámica familiar que pudiera caracterizar el mantenimiento de la sintomatología en los pacientes identificados. La intervención familiar es un elemento importante a considerar para obtener mayores beneficios terapéuticos para el paciente.
RESUMO
Introduction Recent studies have shown an increase in psychiatric symptomatology in medical students and physicians during their professional practice. Some studies show that these professionals have a higher prevalence of psychiatric symptoms than the general population. This phenomenon is a consequence of the particular conditions of this professional activity, and, in the case of students, of high academic demands that lead to stressful situations that interfere with their academic performance and the development of clinical skills, which may have repercussions on their relationship with their patients. The predominant symptoms are anxiety, depression and stress, as well as substance use; there has also been an increase in the number of students with suicide attempts. Most of these problems occur during the first two years of the degree course as well as the internship year. Depression is masked by anger, by virtue of the fact that it is an internalized form of anger. It has also been documented that there is a significant link between certain personality traits and the presence or absence of mental symptoms, regardless of the situations to which people are exposed. The feature with the highest association with the presence of symptomatology is neuroticism, while the personality traits that are most conducive to the achievement of academic success and better adaptation and, therefore, a lower number of symptoms are empathy and kindness. The purpose of this study was to establish a diagnosis of the mental health and personality traits of medical students in the high performance groups and compare them with those of the groups of students that performed poorly during the first two years of the degree course. This transversal, exploratory study involved the participation of 370 students from the UNAM Medical School: 220 belonged to the high performance groups, called educational quality nuclei (NUCE), while 1 50 were repeat students. The variables considered were: age, sex, type of group (NUCE or repeat), academic year (first or second year of the degree), place of origin and type of high school from which they had graduated (public or private). Two instruments were used to measure personality traits and psychiatric symptomatology: the Big Five Personality Traits and the Symptom Check List-90. The results of the study show that in both groups (repeat students and NUCE) over 85% were from the Federal District. Repeat students were mainly women (85.3%) and students from public schools (93.6%). As for the high performance group (NUCE), 83.1 % were from private schools and just 1 6.9% from public schools. Repeat students showed personality traits that included neuroticism and very little openness compared with the high performance groups, which displayed traits of greater openness and less neuroticism, with p<0.01. In general, students from NUCE groups showed traits of greater extraversion, empathy and diligence compared with repeaters. Psychiatric symptomatology was more severe among the repeat group than the NUCE group (p<0.05). The psychiatric symptomatology displayed by both groups included: obsession-compulsion, depression and anxiety. In the comparisons, the two groups showed significant differences in total symptomatology. There were also differences in the following symptomatology, by order of importance: phobia, interpersonal sensitivity, somatization, anxiety, obsessive-compulsive disorder and psychoticism (p<0.05). Differences were found between academic years, with second-year students showing greater symptomatology; women displayed the greatest symptomatology. No differences were found for the interaction between sex and academic year. The analysis of structural models was used to determine the relationship between the variables being studied, with significant correlation coefficients with p<.05 being found between personality and sex, personality and type of high school, as well as type of group and suicidal ideation, academic year and psychiatric symptomatology, personality and suicidal ideation and personality and psychiatric symptomatology. The results of the study coincided with those in the literature, although there were some differences between the two groups of students. Repeat students displayed greater levels of psychiatric symptomatology compared with students in the high performance groups. This suggests that students who perform less well in their degree courses also report higher mean responses in psychiatric symptomatology, mainly on scales of somatization, anxiety, phobia and interpersonal sensitivity. As for type of personality, students in the high performance group reported higher average scores on the scales of extraversion, empathy and openness, with the exception of the neuroticism scale. This suggests that personality features may be predictors of better academic performance as well as greater intellectual skill. This finding is reinforced by the repeater group's results, since they report higher scores in the personality trait of neuroticism. The diligence scale was the same for both groups. The study corroborated the fact that second-year students display the greatest symptomatology, with women reporting higher averages in psychiatric symptomatology scores (mean = 7.3). Sex is associated with greater empathy and solidarity, with women achieving higher scores in both personality traits. Although the neuroticism trait is also associated with the female sex and suicidal ideation, scores for this trait were higher for men. This trait can be considered a predictor for both suicidal ideation and the presence of a higher number of psychiatric symptoms. Lastly, the symptomatology in which these students obtained the highest scores is related to the obsessive-compulsive disorder, a situation which we consider may be due to the type of screening test used. It is a fact that studying medicine involves continuously stressful conditions. For these students, however, seeking help to cope with the presence of psychiatric symptomatology is extremely complicated since they regard it as a form of weakness. This raises the need to develop large-scale programs to orient students in order to enable them to identify symptoms at an early stage, which in turn will permit timely treatment.
En estudios recientes se ha demostrado un incremento en la sintomatología psiquiátrica que presentan los estudiantes de medicina, así como los médicos durante su ejercicio profesional. En algunos estudios se señala que estos profesionistas tienen una prevalencia de síntomas psiquiátricos por arriba de los de la población general. Este fenómeno es una consecuencia de las condiciones propias de la actividad profesional y, en el caso de los alumnos, por situaciones que demandan una mayor exigencia académica, que conlleva a su vez situaciones estresantes que interfieren en su desempeño académico, así como en el desarrollo de habilidades clínicas que pueden repercutir en su relación con los pacientes. Los síntomas que predominan son la ansiedad, la depresión y el estrés, así como el consumo de sustancias; también se ha incrementado el número de estudiantes con intentos de suicidio. Se observa que la mayoría de estos problemas tipo se presentan en los dos primeros años de la carrera, así como en el año de internado. La depresión se encuentra enmascarada por enojo, en virtud de que ésta representa un enojo internalizado. Asimismo se ha documentado que existe una relación importante entre la presencia de ciertos rasgos de personalidad y la presencia o ausencia de síntomas mentales, independientemente de las situaciones a las que se expongan las personas. El rasgo que presenta una mayor asociación con la presencia de sintomatología es el neuroticismo, así como también los rasgos de personalidad que influyen con un mejor cumplimiento de logros académicos y una mejor adaptación. El objetivo de este trabajo fue establecer un diagnóstico de la salud mental y los rasgos de personalidad de los estudiantes de medicina que se encuentran en los grupos de alto rendimiento y compararlo con los grupos de alumnos que presentan bajo rendimiento académico durante los dos primeros años de la carrera. En este estudio exploratorio, de tipo transversal, participaron 370 estudiantes de la Facultad de Medicina de la UNAM: 220 correspondían a los grupos de alto rendimiento, llamados núcleos de calidad educativa (NUCE), y 150 eran alumnos repetidores. De entre los resultados que arrojó el estudio, se encontró que para ambos grupos (repetidores y NUCE) más de 85% provenía del Distrito Federal. En el grupo de repetidores predominaron las mujeres (85.3%) y los alumnos procedentes de escuelas públicas (93.6%). En relación con el grupo de alto rendimiento (NUCE), 83.1% procedía de escuelas privadas y sólo 16.9% de escuelas públicas. Los alumnos repetidores mostraron rasgos de personalidad de neuroticismo y de poca apertura en comparación con los grupos de alto rendimiento, quienes mostraron rasgos de mayor apertura y menor neuroticismo, con una p<0.01. En general, los alumnos de los grupos NUCE mostraron rasgos de mayor extroversión, mayor empatía y diligencia en comparación con los repetidores. La sintomatología psiquiátrica mostró mayor gravedad en el grupo repetidor con respecto al grupo NUCE (p<0.05). La sintomatología psiquiátrica que presentaron ambos grupos fue: obsesión-compulsión, depresión y ansiedad. Entre las comparaciones resultaron diferencias significativas en ambos grupos en el total de sintomatologías. También hubo diferencias en las siguientes sintomatologías por orden de importancia: fobia, sensibilidad interpersonal, somatización, ansiedad, trastorno obsesivo-compulsivo y psicoticismo (p<0.05). Los resultados del estudio presentan coincidencias con lo publicado por la bibliografía; sin embargo, hay diferencias entre ambos grupos de estudiantes. En los alumnos repetidores se observó mayor sintomatología psiquiátrica en comparación con los alumnos de los grupos de alto rendimiento. Por lo anterior, se concluye que los alumnos que presentan menores niveles de logro en la carrera también presentan medias de respuestas mayores en sintomatología psiquiátrica, principalmente en las escalas de somatización, ansiedad, fobia y sensibilidad interpersonal.
