ABSTRACT
Resumen A través del proceso de desarrollo de apego normal y patológico es posible distinguir vulnerabilidades en la formación del sí mismo que podrían contribuir a la emergencia de la psicosis evolutivamente. Para ello revisaré los conceptos básicos del proceso de apego y el desarrollo de la intersubjetividad, los aportes de los estudios longitudinales respecto a la estabilidad, transmisión transgeneracional del tipo de apego y las relaciones entre psicopatología y apego. Expondré sucintamente las hipótesis psicogenética de la psicosis infantil fundamentada en la interacción madre-bebé desde los postulados psicoanalíticos hasta el paradigma más reciente del desarrollo de los sentidos del sí mismo destacando la labilidad en la formación del sí mismo nuclear entre los 2 y 7 meses de vida como una variable importante que puede contribuir a los trastornos psicopatológicos evolutivamente. Se pone en relieve la importancia del tema para la prevención y favorecer la salud mental a lo largo del ciclo vital.
Through the development process of normal and pathological attachment it is possible to distinguish vulnerabilities in the formation of the self that could contribute to the evolutionary emergence of psychosis. I will review the basic concepts of the attachment process and intersubjectivity development, the contributions of longitudinal studies regarding stability, transgenerational transmission of the attachment type and the relationship between psychopathology and attachment. I will briefly explain the psychogenetic hypothesis of infant psychosis based on the mother-baby interaction from the psychoanalytic reflections to the most recent paradigm of the sense development of the self, highlighting the lability in the formation of the nuclear self that happens between 2 and 7 months of life as an important variable that can contribute to psychopathological evolutionarily disorders. Preventing those disorders and benefit mental health throughout the life cycle is highlighted in reviewing this topic.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Psychopathology , Psychotic Disorders , Mental Health , Mothers , Longitudinal StudiesABSTRACT
Background: Anxiety symptoms and anxiety disorders are common among medical patients, however few studies differentiate both and consider the psychiatric comorbidity of anxiety disorders among such patients. Aim: To evaluate the presence of anxiety disorders among patients admitted to a medical ward. Patients and methods: Random selection of 406 patients (mean age 56 years, 203 female), hospitalized in a medical ward of a public hospital, mainly for cardiovascular, genitourinary and digestive diseases. All were assessed using an structured interview for DSM-III-R. Results: Twenty six percent of women and 13% of men had anxiety disorders. Fifteen percent of women and 6% of men had specific phobias, 7% of women and 4% of men had generalized anxiety, 5% of women and 0.5% of men had agoraphobia, 3% of women and 0.5% of men had social phobia, 1% of men and 0.5% of women had panic disorders and 0.5% of women had a post traumatic stress. Specific phobias and social phobias started during childhood. Anxiety and agoraphobia started during adulthood. Among patients with anxiety disorders, 43% of women and 34% of men did not have other psychiatric ailment, 34% of women and 19% of men had an associated depression and 34% of men had disorders due to use of alcohol. Conclusions: A high proportion of patients hospitalized in medical wards have anxiety disorders, that once identified it may help to treat the medical ailments.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anxiety Disorders/diagnosis , Hospitalization , Anxiety Disorders/epidemiology , Chile/epidemiology , Comorbidity , Diagnostic and Statistical Manual of Mental DisordersABSTRACT
Con el propósito de observar la interacción madre-niño y obtener parámetros que permitan evaluar su calidad durante el control del niño sano, en un consultorio externo de la zona sur de Santiago, videograbamos 20 niños entre 4 y 24 meses y a sus madres, todos sanos y calificados, previamente, de "bajo riesgo relacional" en el puerperio inmediato. Al analizar los registros observamos que los siguientes ítems nos permitían apreciar la interacción madre-hijo: desvestir/vestir brusco o delicado; contingencia del llanto del bebé y maniobras de la madre para calmarlo; diálogo madre-niño; juegos madre-niño, flexibilidad de la distancia madre-niño y grado de autonomía del niño. La forma de presentación de cada uno de los mencionados ítems permite discriminar díadas madre-niño con una interacción armónica y aquellas no armónicas. Proponemos una pauta que, aplicada en el control del niño sano, podría contribuir a detectar díadas con problemas de relación antes que se transformen en trastornos del vínculo y problemas de salud mental en los niños.
Subject(s)
Humans , Female , Infant , Infant Care , Mental Health , Mother-Child Relations , ChileABSTRACT
Background: Studies done in Chile and abroad report a high frequency of substance abuse among patients hospitalized in general medical services. Aim: To report the frequency of substance abuse in a sample of patients hospitalized in a public hospital of Santiago. Material and methods: A structured psychiatric interview for the Third Revised Version of The Diagnostic and Statistical Manual (DSM-III-R) was applied to 203 males, aged 58.5 years and 203 females, aged 52,9 years, hospitalized in an internal medicine Service of a public hospital. All subjects had a low educational and income level. Results: The discharge diagnoses of studied patients were digestive diseases in 32 percent, circulatory diseases in 19 percent, cancer, diabetes mellitus and genitourinary diseases in 11 percent respectively and mental or behavioral diseases in 5 percent. Thirty eight percent of males and 6 percent of females qualified for alcohol dependency or abuse in some moment of their lives. The figures for benzodiazepine dependency were 1 percent among males and 6 percent among females. The figures for cannabis, cocaine or stimulant abuse were 1.5 percent for males and 1 percent for females. Other conditions of the axis 1 of DSM-IIIR were diagnosed in 47 percent of males and 65 percent of females with substance abuse. Conclusions: Substance abuse underlies medical conditions in a high proportion of patients admitted to medical services in general hospitals
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Anxiety Disorders , Alcoholism , Depression/epidemiology , Cocaine-Related Disorders/epidemiology , Bipolar Disorder , Comorbidity , Marijuana Abuse , Prevalence , Alcoholism , Substance Abuse Detection , Socioeconomic Factors , Phobic Disorders/epidemiology , Cocaine-Related Disorders/psychologyABSTRACT
Background: Mental disorders may interfere, aggravate or mimic medical conditions. Aim: To study the prevalence of psychiatric disorders among patients hospitalized in a medical ward of a general hospital. Patients and methods: A structured interview for DSM-III, devised for "non patients", was applied to 203 men and 203 women, aged 11 to 90 years old, hospitalized in an internal medicine service of a public hospital. Thirty four psychiatric conditions that can be discriminated with the instrument and others that complied with DSM-III criteria, were investigated. Results: There was a 60 percent prevalence of mental disorders among men (alcohol dependency in 26 percent, delirium or dementia in 10.8 percent, anxiety disorders in 10.4 percent, major depression in 7.8 percent and adaptation disorders in 3 percent). Among women, the prevalence of mental disorders was 65 percent (major depression in 23.2 percent, anxiety disorders in 14.3 percent, adaptation disorders in 8.4 percent, dementia in 5.6 percent, delirium in 3 percent and alcohol dependency in 2.5 percent). Most conditions were of moderate or mild intensity. Two or more conditions coexisted in 40 percent of cases. Only in 8 percent of these subjects, a psychiatric consultation was requested. Conclusions: There is a high frequency of psychiatric disorders among medical patients. These must be adequately diagnosed and treated
Subject(s)
Humans , Male , Female , Hospital Departments , Mental Disorders , Depressive Disorder, Major/epidemiology , Interview, Psychological , Psychiatric Status Rating Scales/statistics & numerical data , Demographic IndicatorsABSTRACT
The biomedical model has successfully reduced mother and child mortality and diseases during the labor and puerperal period. In the perinatal period, the mother and her offspring can also have psychosocial problems, that have been insufficiently studied and that we propose considering. Based on neurobiological information, on bonding theory and on a focus change in the everyday work of human behavior experts in maternity hospitals, we propose that perinatal mental health should have an important place and can be harmoniously articulated with the biomedical model. This mental health work should aim at generating safe mother-child bonds. It should be maintained Thereafter through social networks to prevent child abuse, to promote healthy development and to prevent psychopathology. We review some of the programs carried out in the ten year period in which we have worked as a mental health team in the maternity ward of a public hospital in Santiago, Chile
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Pregnancy/psychology , Mental Health , Postpartum Period/psychology , Perinatal Care/trends , Maternal Behavior/psychology , Maternal Health Services/trendsABSTRACT
The purpose of this work was to construct and assess a scale aimed to detect risky relationship between mothers and newborns that could predict future child abuse and neglect. The instrument was applied in 2 opportunities, by a trained midwife and by expert in mental health, to a sample of 106 mother-newborn dyads. When both assessments were compared, the concordance to assess relationship risk was 99.3 percent. The reliability of the scale, measured with the Crombach, a internal consistence index, was 0.88. Those items with a low discriminative capacity were eliminated. The massive use of the resultant scale, that is easy to apply and highly reliable, could help to prevent child abuse and neglect