Child and adolescent Liaison-Consultation Psychiatry and Psychosomatic Medicine in a Clinical-Teaching Hospital. / Psiquiatría de Enlace y Medicina Psicosomática Infanto Juvenil en un Hospital Clínico-Docente.

Psychosomatic medicine explores the psychological, behavioral, and social elements that influence people's health and quality of life. This discipline develops skills and knowledge used in the evalua tion and management of psychosocial elements interfering in the process of illness and healing. The Child and Adolescent Consultation-Liaison Psychiatry (CACLP) is a discipline that has been empi rically installed in order to favor adherence to treatments and recovery of children and teenagers du ring the process of illness. There is a need for developing this discipline in Chile, but so far there are limited national and international records and literature dedicated to it. The objective of this article is to update the concepts of structure and describe how a CACLP unit in a high complexity teaching hospital works in general, discussing the clinical challenges involved in these issues.

Health Issues Among Healthcare Workers During COVID-19 Pandemic: a Psychosomatic Approach.

Healthcare workers as the front-liner to fight COVID-19 pandemic, need reassurance of their safety. The stress and the demands from the healthcare system can affect their health as well as the morality. Hence, psychosomatic approach should be used to keep their condition in good shape. The combination between biological, psychological, and social approaches may affect their vulnerability from SARS-CoV-2 infection. The biological aspect includes personal protective equipment, nutrition, and resting/sleeping time. The psychological distress is shown to affect the immune system; and mental relaxation and management of work shift may reduce the distress. There should be an effort from the stakeholders to keep the morality of the healthcare workers. The social aspect such as providing place to live, having supportive family members, and avoiding stigmatization also improve their psychological health. In conclusion, psychosomatic approach is important to keep the healthcare workers healthy.

[Internal medicine between soma and psyche : Functional bodily complaints and depressive disorders in outpatient care]. / Innere Medizin zwischen Soma und Psyche : Funktionelle Körperbeschwerden und depressive Störungen in der ambulanten Versorgung.

Somatoform disorders are encountered in primary medical care with above-average frequency but are too rarely named as such in the differential diagnostics. The prevalence is approximately 30 % with a predominance of female patients. This patient group puts the physician-patient relationship to the acid test from the very beginning due to the fixation on organ-related symptoms, the expectations of repeated instrumental diagnostics and the special way of acting. The consequences are frequent changes of physicians, chronification and disappointment on both sides; however, a workable physician-patient relationship can be developed through an empathic but critically distanced fundamental attitude of the general internist based on a biopsychosocial illness concept. In the further course corrections in the understanding and expression of the illness on the part of the patient can be achieved with a pacing and leading strategy and with psychoeducative measures. The primary psychologization of functional complaints will not satisfy the affected person but outpatient psychotherapy should be initiated only after the patient has been well-prepared. Measures with medications mostly remain unspecific and serve only for relief of symptoms. For comorbidities with anxiety and/or depressive disorders the use of selective serotonin reuptake inhibitors should be considered.

Emotion, Social Relationships, and Physical Health: Concepts, Methods, and Evidence for an Integrative Perspective.

Emotional characteristics and processes are robust predictors of the development and course of major medical illnesses and premature mortality, as are a variety of indicators of the presence and quality of personal relationships. Despite clear evidence of close interconnection between these two domains of risk and protection, affective characteristics and relationships have largely been studied separately as influences on health. After a recent conference on integrative perspectives on emotions, relationships and health co-sponsored by the American Psychosomatic Society and the Society for Affective Science, the present review builds on prior calls for integration, related theory, and current research to outline what is known about the interconnection of these domains as it specifically relates to their overlapping influences on health. Areas of interest include the following: their interconnected roles over the course of development, which may inform current efforts to understand the influence of early life events on adult health; the parallel positive and negative factors in both domains that could have distinct influences on health; the role of emotion regulation in relationship contexts; and measurement, design, and analysis approaches to capture the dyadic and dynamic aspects of these interconnected influences on health. We conclude with a discussion of an emerging research agenda that includes the following: common biological foundations of affective and relationship processes, the cultural embeddedness of affective and relationship processes, the potential contribution of affective-relational processes to health disparities, and implications for intervention research.

Between the Error Bars: How Modern Theory, Design, and Methodology Enrich the Personality-Health Tradition.

The study of relationships between personality traits and health has a long history in psychosomatic research. However, personality science has evolved from an understanding of personality as fixed traits to one that acknowledges that personality is dynamic. Dynamic approaches to conceptualizing and measuring personality and individual differences can enrich personality-health research. In this Presidential Address (American Psychosomatic Society, 2018), I consider how different formulations of personality-stable traits, stable signals in a noisy or variable measure, within-person changes, and intraindividual variability-can be implemented to better understand how personality is related to health and particularly to immune function. These approaches recognize and, in some cases, capitalize on the fact that personality factors can display variability as well as stability over time. They also require repeated measurement and therefore greater methodological sophistication that considers reliability and generalizability, Simpson's paradox, and the difference between variability and flexibility. Dynamic qualities of personality and individual differences potentially influence health, and designs and methodology that incorporate them can illuminate the important processes that occur inside the error bars.

A short intervention targeting psychosomatic care in older adults with complex health care needs-results of a randomized controlled trial.

OBJECTIVE: The aim of this randomized controlled trial (RCT) was to assess the efficacy of a short intervention targeting psychosomatic care in older adults with complex health care needs. METHODS: Participants were recruited in the frame of the 11-year follow-up of a large population-based study by means of the INTERMED interview. The INTERMED interview is an integrative assessment method to identify bio-psycho-social health care needs. Persons with high health care needs (interview score ≥ 17) were invited to take part. Participants were randomized with a 1:1 ratio to a control and an intervention group. The intervention group received a home visit conducted by a doctor trained in psychosomatic medicine. The primary hypothesis stated that the intervention group would have a better outcome with respect to health related quality of life (HRQOL) measured by the 12-item short-form health survey (mental component score, MCS) 6 months after randomization (T1). Secondary outcomes were physical HRQOL, health care needs, depression, anxiety, and somatic symptom severity. RESULTS: In total, 175 participants were included. At the three-year follow-up (T2), 97 participants (55.4%) were included. At T1, we did not find a difference regarding MCS between the intervention and control groups. At T2, the intervention group showed significantly lower health care needs compared with the control group. Regarding HRQOL, depression, and somatic symptom severity the two groups did not differ at T2. CONCLUSIONS: The primary hypothesis was not confirmed. However, results indicate that a short intervention with complex patients could lead to reduced bio-psycho-social health care needs.

Hacia una intervención psicosomática a medida / Pour une intervention psychosomatique sur mesure / Moving towards a tailor-made psychosomatic approach

En este texto se presentan la síntesis y las conclusiones de un trabajo psicoterapéutico realizado en equipo con pacientes oncológicos y sus familiares. Utilizando las herramientas, que son básicamente la psicosomática de la Escuela de París y la experiencia del trabajo en grupos, el equipo muestra la originalidad de organizar las psicoterapias de grupo y las sesiones individuales adaptadas a las capacidades del funcionamiento mental de cada paciente. (AU)

In this text, we present the synthesis and conclusions of a psychotherapeutic work done by a team with oncological patients and their relatives. Using tools that are basically the Psychosomatics of the Scof Paris and the experience of working in groups, the team demonstrates the originality of organizing group psychotherapies and individual sessions that are adapted to the capacities of the mental functioning of each patient. (AU)

Dans ce texte sont présentées la synthèse et les conclusions d’un travail psychothérapeutique mené en équipe avec des patients oncologiques et leurs proches. Utilisant les outils, qui sont essentiellement la psychosomatique de l’École de Paris et l’expérience du travail en groupe. L’équipe montre l’originalité de l’organisation de psychothérapies de groupe et des séances individuelles adaptées aux capacités du fonctionnement mental de chaque patient. (AU)

Implementation of an electronic routine outcome monitoring at an inpatient unit for psychosomatic medicine.

BACKGROUND: Patient-reported outcomes (PROs) can be part of an electronic routine outcome monitoring (eROM). eROM can improve patient involvement, treatment outcomes and simplify scientific data assessment. Available studies on eROM focus on its evaluation only and lack a detailed description of the prior implementation procedure. OBJECTIVE: The aim was to implement an eROM assessment at a division of Psychosomatic Medicine and provide a detailed description of the implementation procedure. METHODS: According to the Replicating Effective Program concept the project consisted of 4 phases: pre-condition (1), pre-implementation (2), implementation (3) and maintenance and evolution (4) mainly focusing the description of the implementation procedure and a short evaluation. RESULTS: We describe the actions taken during the implementation procedure and steps which were taken to overcome identified barriers. All decisions were carried out based on the Participatory Action Research process. A core set consisting of sociodemographic and clinical data and a comprehensive questionnaire battery covering symptoms, functioning parameters and psychological constructs was implemented. In total 164 patients, took part in the eROM assessment from June 2015 to December 2016. The evaluation showed that eROM was appreciated by health-care professionals (85.2%) and patients (70.2%) alike. The majority of patients (89.4%) and health-care professionals (85.7%) experienced no delays in daily clinical routine due to eROM. CONCLUSION: The detailed description of the implementation process can guide institutions planning to implement eROM into their daily clinical routine. Focusing scientific efforts on the implementation process is essential since this influences all further steps such as evaluation and acceptance.

Psiquiatría psicosomática del niño y adolescente con enfermedades crónicas digestivas / Psychosomatic psychiatry of the child and adolescent with chronic digestive diseases

Las enfermedades crónicas infantiles influyen negativamente en el desarrollo psicológico. Los niños y adolescentes con enfermedades crónicas digestivas presentan de forma predominante síntomas ansiosos y depresivos. Factores ambientales como el manejo de la sintomatología, la influencia de la respuesta de los pares o de la propia familia pueden determinar el manejo que de la enfermedad tenga el paciente. Estos aspectos son muy relevantes en enfermedades como la Enfermedad de Crohn, la Colitis Ulcerosa, el Dolor Abdominal Recurrente y los Vómitos Psicógenos. Los factores psicológicos que afectan a enfermedades médicas y/o la presencia comórbida de patología mental disminuyen la calidad de vida de estos pacientes afectando también al sistema familiar. La medicina psicosomática aborda estos aspectos de dichas patologías ayudando al paciente y a sus familias. Un abordaje integral por parte digestivo y de salud mental incrementa la salud percibida de los niños y adolescentes con patología digestiva crónica

Chronic childhood diseases negatively influence on the child's psychological development. Children and adolescents with chronic digestive diseases have predominantly anxious and depressive symptoms. Environmental factors such as management of gastrointestinal symptoms, the influence of the response of peers or family itself can determine the handling of the disease. These aspects are very important in diseases like Crohn's disease, ulcerative colitis, recurrent abdominal pain and psychogenic vomiting. Psychological factors affecting medical conditions and / or the presence of comorbid mental illness diminish the quality of life of these patients also the family system is affecting. Psychosomatic medicine addresses these aspects of these diseases helping patients and their families. A comprehensive approach to improving gastrointestinal and psychiatric symptoms increases the perceived health of children and adolescents with chronic digestive diseases

Diferentes destinos de lo no neurótico: introducción al tema monográfico / No disponible

No disponible

La psicosomática y los estados no representados / Psychosomatic illness and unrepresented states

Para muchos analistas, la aplicación del pensamiento psicoanalítico a la comprensión y tratamiento de las condiciones somáticas ha sido problemática y perturbadora. Para tales condiciones, los supuestos clínicos del modelo arqueológico del psicoanálisis que funcionan tan bien para las neurosis no parecen suficientes. Este artículo intentará revisar y reubicar el problema de la psicosomática desde la perspectiva de los estados no representados y la transformación del modelo del psicoanálisis discutiendo las complejidades de la etiología, las perspectivas contemporáneas sobre la construcción, la elaboración de mitos y la reorganización apres-coup [Nachträglichkeit] y concluirá con un breve ejemplo clínico (AU)

For many American analysts, the application of psychoanalytic thinking to the understanding and treatment of somatic conditions has been problematic and disappointing. For these conditions, the clinical assumptions of the archeological model of psychoanalysis that work so well for neurosis do not seem to suffice. This paper will attempt to review and restate the problem of psychosomatics from the perspective of unrepresented states and the transformational model of psychoanalysis, discussing the complexities of aetiology, contemporary views of construction, myth making and après coup [Nachträglichkeit] and will conclude with a brief clinical example (AU)

La psicosomática en el psicoanálisis contemporáneo / Pschosomatics in contemporary psychoanaysis

La autora considera que hoy día la psicosomática está en el centro del campo psicoanalítico. Para ello describe dos funcionamientos psíquicos que conviven: el psiconeurótico o edípico y el no-neurótico, donde estarían, entre otras, las somatosis. A la vez, señala la idea de dos inconscientes: uno reprimido o edípico y otro no reprimido o genuino o propiamente dicho, origen del funcionamiento no-neurótico y residencia de las huellas sensoriales traumáticas primitivas, que no han tenido traducción psíquica y que, al ser investidas por un acontecimiento actual, traumas o duelos, pueden desencadenar, entre otros, un fenómeno somático. También describe el abordaje clínico de estos pacientes, que de entrada suelen exigir el uso de un encuadre creativo, la instrumentación de la contratransferencia y la elaboración de construcciones, ilustrando sus ideas con un material clínico (AU)

The author considers that nowadays psychosomatics is at the core of the psychoanalytic field. She describes two kinds of psychic functioning that coexist: a psycho-neurotic or Oedipal functioning, and another, non-neurotic, where she includes somatosis. Likewise, she puts forward the idea of two unconscious systems: one is repressed or Oedipal, while the other is non-repressed, genuine or the Unconscious proper. The latter constitutes the origin of the non-neurotic functioning and contains primitive, traumatic sensory traces, which haven't been turned into psyche and which, on being invested by a present occurrence: such as traumas or important losses that need to be mourned, may uncham a somatic phenomenon (among others). The author also describes the clinical approach to these patients, who usually demand the use of a creative setting the instrumentation of counter-transference, and the use of constructions. She illustrates these ideas with a clinical material (AU)

Terapia autógena: técnicas, fundamentos, aplicaciones en la salud y clínica y apoyo empírico / Autogenic therapy: techniques, foundations, health and clinical applications, and empirical support

La terapia autógena se origina en el entrenamiento autógeno de Schultz y en su desarrollo incorpora diferentes métodos terapéuticos de orientación psicofisiológica creados para promover procesos cerebrales homeostáticos autorregulatorios. Los objetivos de este artículo son describir y analizar los diferentes métodos autógenos, los procesos psicofisiológicos y neurofisiológicos implicados y sus aplicaciones eficaces en la salud y la clínica. Para ello, además de revisar los primeros trabajos de Schultz y Luthe, se ha hecho una búsqueda electrónica de estudios para encontrar contribuciones relevantes sobre estos temas. Los resultados muestran un gran desarrollo de los métodos autógenos hasta los años 80, con una ingente cantidad de aplicaciones y estudios sobre los cambios psicofisiológicos y neurofisiológicos concomitantes. Sin embargo, su expansión durante los últimos 25 años ha sido mucho menor en comparación con métodos como el mindfulness o la hipnosis. Se discuten posibles causas y se plantean retos futuros para la terapia autógena

Autogenic therapy emerges from the "autogenic training" method created by Schultz, and its development incorporates different therapeutic methods based on a psychophysiological approach. All these methods promote homeostatic self-regulatory brain processes. The aims of this paper are to describe and analyse the autogenic methods, the psychophysiological and neurophysiological processes involved, and their effective applications in both health and clinical fields. For these purposes, beside reviewing the earlier work by Schultz and Luthe, an electronic search of literature was conducted in order to find relevant contributions on these topics. Results show a big development of autogenic methods until the 80s, with an enormous amount of applications and studies on the psychophysiological and neurophysiological changes related to the practice of autogenic training. However, their expansion during the last 25 years has been much lower in comparison with other methods such as mindfulness and hypnosis. Possible causes are discussed and new challenges are suggested

Propuestas de acercamiento al diagnóstico de la afectación y el padecer en la carrera de Medicina / Approach proposals to the diagnosis of affectation and suffering in the medicine career

Introducción: A pesar del tiempo transcurrido, el paradigma biologicista de atención médica no ha sido sustituido por el paradigma biopsicosocial. En el programa de la carrera no hay definición clara de los términos para que los estudiantes de Medicina en su tercer año, durante la estancia en salas de Medicina Interna se acerquen al diagnóstico de la afectación y el padecer. Objetivo: Elaborar una propuesta argumentada de acercamiento al diagnóstico de la afectación y el padecer por estudiantes de Medicina durante su estancia en salas de Medicina Interna. Material y Métodos: Se realizó una revisión narrativa de la literatura seleccionada, obtenida mediante el motor de búsqueda Google Académico y la base de datos Scielo de la Biblioteca Virtual de Salud. Resultados: El Índice de Barthel permite suficiente acercamiento al diagnóstico de la discapacidad como concepto asociado a la afectación. La respuesta emocional del paciente puede definirse como adaptativa adecuada conveniente o como inadaptativa inadecuada inconveniente para la solución de su problema de salud. Conclusiones: Se proponen términos concretos para el acercamiento al diagnóstico de la afectación y el padecer para el estudiante de Medicina(AU)

Introduction: In spite of the elapsed time the biologistic paradigm of medical attention has not been substituted by the bio psychosocial. In the careers program, there is no obvious definition of terms in order that the third year medicine students, during their stay in the Internal Medicine wards, approach to the diagnosis of affectation and suffering.Objective: Elaborate an argued proposal of approach to the diagnosis of affectation and suffering for students of medicine during his stay in Internal Medicine wards. Material and Methods: Was performed a narrative revision of the selected literature obtained by means of the computer search engine google academic and SciELO data base of the Healths Virtual Library. Results: Barthel's index enables an enough approach to the diagnosis of the disability as a correlated concept with affectation. The patient's emotional reaction can be defined as adequate adaptive -convenient or inadequate inconvenient and maladaptive for the solution of his problem of health.Conclusions: The authors propose specific terms for the approach to the diagnosis of affectation and suffering for the student of medicine(AU)

[DGPPN compass of participation for vocational integration of persons with mental illnesses]. / DGPPN-Teilhabekompass zu beruflichen Integrationsmaßnahmen für Menschen mit psychischen Erkrankungen.

Working and living for persons with mental illnesses are a major concern of rehabilitative psychiatry. In Germany the definition of rehabilitation for persons with mental illnesses is closely linked to different sectors of social welfare and to the strongly organized supply chain of prevention, acute treatment, rehabilitation and care. In successfully supporting people with mental health problems in terms of vocational integration, professionals face various obstacles. Besides finding the correct content, structural and organizational difficulties can also arise. The welfare system with its specific institutions and settings is complicated which often leads to delays in the onset of rehabilitation. Some essential reasons are insufficient knowledge about established options of rehabilitative treatment and about responsibilities related to participation in specialized training and further education for professional caregivers. Also information and (positive) experiences from pilot projects working in an inclusive, cross-sectional way and across different settings are practically unavailable in Germany. The presented compass of participation from the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) for vocational integration of persons with mental illnesses starts at this point: it provides guidelines for psychiatric and psychotherapeutic practitioners, general practitioners as well as for physicians working in residential or day care institutions with a psychiatric and psychotherapeutic background. Both the paper and planned online versions should help professionals to help people, particularly those with severe mental illnesses to navigate the system of services for vocational integration in Germany.

La eficacia del tratamiento individual de los acúfenos subjetivos con terapia cognitiva-conductual / The efficacy of individual treatment of subjective tinnitus with cognitive behavioural therapy

Introducción: Los acúfenos subjetivos, a pesar del tiempo transcurrido desde que fueron descritos por primera vez, continúan sin tener un tratamiento con eficacia demostrada. El objetivo de este artículo es valorar la eficacia de la terapia cognitiva-conductual en el tratamiento de estos enfermos. Pacientes y métodos: Durante un periodo de tiempo de los años 2012-2013 se estudia a 310 enfermos que presentaban acúfenos subjetivos. De ellos, 267 fueron incluidos en un tratamiento basado en terapia cognitiva-conductual. El periodo de seguimiento fue de 18 meses y en 11 enfermos de 21 meses. Resultados: Considerando los enfermos que interrumpieron el tratamiento como fracasos, el porcentaje de curación fue de 95,7%. Conclusión: La terapia cognitiva-conductual debe estar siempre incluida en el tratamiento de los enfermos de acúfenos (AU)

Introduction: It has been a long time since subjective tinnitus cases were described for the first time but they still lack a treatment with proven effectiveness. The main goal of this study was to evaluate the effectiveness of cognitive behavioural therapy in these patients. Patients and method: Between 2012 and 2013, 310 patients that suffered from subjective tinnitus were studied. Of these, 267 were included in treatment based on cognitive behavioural therapy. The monitoring period lasted 18 months for most cases, while it lasted 21 months for 11 patients. Results: Considering patients that interrupted their treatment as failures, the percentage of recovery was 95.7%. Conclusion: Cognitive behavioural therapy should always be included in the treatment of people suffering from tinnitus (AU)

Practice Patterns Revisited in Pediatric Psychosomatic Medicine.

BACKGROUND: Given the heightened focus on the implementation of integrated care and population health management strategies, there is a critical need for an analysis of pediatric psychosomatic medicine (PPM) programs. OBJECTIVE: The goal was to survey current practice patterns in academic PPM programs in North America regarding their service composition, clinical consultation services, changes in service demand, funding, and major challenges so as to inform and support advocacy efforts on behalf of children in their need for responsive and effective PPM services. RESULTS: With a 52.5% survey response rate from 122 child and adolescent psychiatry programs in North America, the demand for PPM services was reported to have significantly increased over the past decade as seen in the described expansion in clinical consultation services and the reported higher patient acuity, as well as new responsibilities in the care of youth with psychiatric illnesses who require boarding on medical inpatient services. Although an increased willingness by hospital administrators to fund PPM services was apparent, adequate funding remained a core issue. Although the value of research is well recognized, few programs are engaged in systematic PPM investigation. CONCLUSION: This survey provides evidence that the current field of PPM appears to be in an increasingly stronger position within academic medical centers. It is just as apparent today, as it has been in the past, that there is a need to communicate at local, regional, and national levels that PPM is an essential behavioral health service.