Terapêutica Centrada na Pessoa / Person-centered Therapeutics

A eficácia de um clínico no tratamento depende substancialmente de sua atitude em relação ao ­ e compreensão do ­ paciente como uma pessoa dotada de autoconsciência e determinação para direcionar seu próprio futuro. A avaliação da personalidade na sessão terapêutica é uma base fundamental para formar uma aliança de trabalho eficaz, compartilhando os mesmos objetivos. Ajudar uma pessoa a refletir sobre sua personalidade fornece um reflexo de suas fortalezas e vulnerabilidades na adaptação aos muitos desafios da vida. O Inventário de Temperamento e Caráter (ITC) fornece uma maneira eficiente de descrever a personalidade minuciosamente e de prever os aspectos positivos e negativos da saúde. Forças e fraquezas nos traços de personalidade do ITC permitem sólidas previsões das diferenças individuais de todos os aspectos do bem-estar. Diversas técnicas terapêuticas, como dieta, exercícios, autorregulação do humor, meditação ou atos de gentiliza influenciam a saúde e o desenvolvimento da personalidade de maneiras que são indistinguíveis umas das outras ou de tratamentos alopáticos eficazes. Assim, o desenvolvimento do bem-estar parece ser o resultado da ativação de um conjunto sinérgico de mecanismos de bem-estar, que são expressos por meio de funcionamento, plasticidade e virtude mais completos na adaptação aos desafios da vida.

A clinician's effectiveness in treatment depends substantially on his or her attitude toward ­ and understanding of ­ the patient as a person endowed with self-awareness and the will to direct his or her own future. The assessment of personality in the therapeutic encounter is a crucial foundation for forming an effective working alliance with shared goals. Helping a person to reflect on their personality provides a mirror image of their strengths and weaknesses in adapting to life's many challenges. The Temperament and Character Inventory (TCI) provides an effective way to describe personality thoroughly and to predict both the positive and negative aspects of health. Strengths and weaknesses in TCI personality traits allow strong predictions of individual differences of all aspects of well-being. Diverse therapeutic techniques, such as diet,exercise, mood self-regulation, meditation, or acts of kindness, influence health and personality development in ways that are largely indistinguishable from one another or from effective allopathic treatments. Hence, the development of wellbeing appears to be the result of activating a synergistic set of mechanisms of well-being, which are expressed as fuller functioning, plasticity, and virtue in adapting to life's challenges.

Effect of 593C>T GPx1 SNP alone and in synergy with 47C>T SOD2 SNP on the outcome of critically ill patients.

During critical illness and sepsis there is severe antioxidant depletion, and this scenario raises the critical ill patient's mortality risk. Glutathione peroxidase (GPx) is one of the first endogenous antioxidant defense enzymes, and it works cooperatively with superoxide dismutase (SOD) and catalase (CAT) to detoxify free radicals from the cellular environment. Genetic studies are important to understand the complexity of human oxidative stress and how the organism responds to an extreme situation such as critically care conditions. Previous studies with a GPx1 single nucleotide polymorphism (593C>T SNP; rs1050450; protein variant in GPx1: Pro198Leu) showed 593T carriers and 593TT homozygotes present higher risk to develop different diseases. We assessed the relationship of the genotype distribution of GPx1 SNP in critically ill patients with their conditions (organ dysfunction, sepsis, and septic shock) and their outcome. We monitored 626 critically ill patients daily from the ICU (intensive care unit) admission to their discharge from hospital, or death. Our study revealed a significant association between 593TT GPx1 genotype and mortality; the mortality rate was higher in homozygous 593TT GPx1 (N=94) when compared with the group of subjects with genotypes 593CT or 593CC GPx1 (N=532) (52% vs. 38%, P=0.009; OR=1.79; 95% CI=1.13-2.85). Evaluating the subgroup of 293 ICU patients with sepsis, a pooled analysis including two genetic variants GPx1 and SOD2 (47C>T SNP, rs4880; protein variant in MnSOD: Ala-9Val) showed a significant difference in relation to progression to septic shock. The frequency of septic shock among septic patients with 593T GPx1 and 47C SOD2 alleles (N=122) was higher when compared with septic patients carrying other settings of genotypes (N=174) (78% vs. 66%; P=0.028; OR=1.81; 95% CI=1.03-3.18). Accepting the previously reported functional effects of these two SNPs on GPx1 and SOD2 gene expressions and, consequently, on GPx1 and MnSOD enzyme activities, we believe our results may be considered as an important contribution for the understanding of oxidative imbalance during the critical ill.