Family psychotherapy in patients with uncontrolled hypertension. Preliminary study.

BACKGROUND: Family psychotherapy has been shown to have a positive impact on the evolution of patients with psychosomatic disorders, and in those with arterial hypertension it could improve the level of control of the disease. OBJECTIVE: To evaluate the impact of an intervention in family psychotherapy in patients with uncontrolled systemic arterial hypertension. METHOD: Study with comparative groups. 15 uncontrolled hypertensive patients, assigned to 2 groups: an intervention group of 10 patients who received family psychotherapy and a control group of 5 patients. In both groups, the pharmacological treatment indicated by experts was continued. Both groups were compared before and after the intervention regarding quality of life (InCaViSa), family functioning (Family Functioning Scale), systolic and diastolic blood pressure, body mass index and glucose, cholesterol, triglycerides, uric acid and creatinine. RESULTS: There was qualitative improvement in the domains of the InCaViSa scale to estimate quality of life in the intervention group and there were no statistically significant changes between the groups in family functioning or in body weight. Among the biochemical variables, only cholesterol showed a significant reduction (p = 0.47). Greater mobility of the family towards more functional behaviors was found in the group that received the intervention, and also in this group, systolic and diastolic blood pressure values decreased (p < 0.001), and the use of antihypertensive, anxiolytic and antidepressant drugs, as well. CONCLUSIONS: Family psychotherapeutic intervention can favor the control of blood pressure, reduce the doses of antihypertensive, anxiolytic and antidepressant drugs and it can help to transition to better functionally family states.

ANTECEDENTES: La psicoterapia familiar ha demostrado tener un impacto positivo en la evolución de enfermos con trastornos psicosomáticos, y en aquellos con hipertensión arterial arterial pudiera mejorar el nivel de control de la enfermedad. OBJETIVO: Evaluar el impacto de una intervención en psicoterapia familiar en pacientes con hipertensión arterial sistémica no controlada. MÉTODO: Estudio con grupos comparados. 15 pacientes hipertensos no controlados, asignados a dos grupos: un de intervención, con 10 pacientes que recibieron psicoterapia familiar, y otro de control con 5 pacientes. En ambos grupos se continuó con el tratamiento farmacológico indicado por expertos. Se compararon ambos grupos antes y después de la intervención respecto a calidad de vida (InCaViSa), funcionamiento familiar (Escala de Funcionamiento Familiar), presión arterial sistólica y diastólica, índice de masa corporal, glucosa, colesterol, triglicéridos, ácido úrico y creatinina. RESULTADOS: Hubo una mejoría cualitativa en los dominios de la escala InCaViSa para estimar la calidad de vida en el grupo de intervención y no hubo cambios estadísticamente significativos entre los grupos en cuanto a funcionamiento familiar y peso corporal. Entre las variables bioquímicas, solo el colesterol mostró una reducción significativa (p = 0.47). Se encontró una mayor movilidad de la familia hacia comportamientos más funcionales en el grupo que recibió la intervención, y también en este grupo disminuyeron las cifras de presión sistólica y diastólica (p < 0.001), así como el uso de antihipertensivos, ansiolíticos y antidepresivos. CONCLUSIONES: La intervención psicoterapéutica familiar puede favorecer el control de la presión arterial, reducir las dosis de antihipertensivos, ansiolíticos y antidepresivos, y ayudar en la transición a estados de mejor funcionalidad familiar.

[The family system and the allergic child. Notes about the role of the symptoms in family functioning]. / El sistema familiar y el niño alérgico. Apuntes sobre el papel del síntoma en el funcionamiento familiar.

This paper reports the role of children with some chronic disease, particularly allergic, into his/her familial system about the control of the disease (emphasizing the role of symptoms). Approach is done since a systemic perspective, where vision of isolated individual losses preponderance and the phenomenon is studied in its relational context. When family does not have the necessary resources to effectively confront a crisis, how familial functioning influences the appearing or disappearing of situations of personal and familiar risk should be explored. The symptom is the expression of some general dysfunction in familial organization and actively represents the most powerful reinforcement of the rigid familial homeostasia. Interpretation and treatment of allergic symptoms depend greatly on the form family interprets and understands its recurrence. Impact of family on chronicity of its child's allergic diseases, exacerbations and repercussions in the degree of illness' control should be studied. In cases of difficult control of the disease and when environmental control measurements, immunotherapy and pharmacological treatment do not offer the expected advantages, the family should be studied and psycotherapeutic support with trained personnel must be given.