Modelos conceptuales y explicativos sobre las crisis no epilépticas psicógenas (CNEP) / Conceptual and explanatory models of Psychogenic Non-Epileptic Seizures (PNES)

Las Crisis No Epilépticas Psicógenas (CNEP) son episodios similares a las crisis epilépticas, pero a diferencia de éstas, no son causadas por la actividad eléctrica anómala del cerebro. Se diagnostican una vez descartadas otras causas fisiopatológicas. El objetivo de este artículo es presentar la conceptualización actual de este fenómeno. Para ello, en primer lugar realizaremos una historización del fenómeno, relacionándolo con la categoría de histeria; segundo lugar, describiremos las clasificaciones propuestas por las distintas ediciones del Manual Diagnóstico y Estadístico de los trastornos mentales, destacando su última versión (DSM-V); finalmente, introduciremos las corrientes actuales que explican este fenómeno, las cuales toman el rol de la disociación como categoría central que explica tanto el diagnóstico así como los objetivos de tratamiento para las CNEP. La categoría disociación es la clave para entender la dirección en la que se está avanzando en psicopatalogía, la búsqueda de los procesos psicológicos específicos subyacentes para entender el mecanismo que lleva a producir tanto las CNEP como otros cuadros de psicopatológicos.

Psychogenic Non Epileptic Crises (CNEP) have been a challenge to diagnostic and explanation for the mental health field. They are diagnosed after discard out other pathophysiological causes of the crisis. They are similar to epileptic seizures, but unlike these, they are not caused by electrical activity in the brain. In order to present the current conceptualization of this phenomenon, we propose in first place to describe its historical development, second, the current classification of the Diagnostic and Statistical Manual (DSM-V), third, to introduce the present currents that explain this phenomenon by taking the role of dissociation as a central category that explains the diagnosis and the treatment objectives for the CNEP. The dissociation category is the key to understand the direction in which progress is being made in psychopathology, the search for the specific underlying psychological processes to understand the mechanism that leads to producing both the CNEP and other psychopathological frames.

Cambio conceptual sobre infarto agudo del miocardio en estudiantes de ciencias de la salud / Conceptual change on acute myocardial infarction among health sciences students

Resumen Objetivo: caracterizar de los modelos explicativos sobre infarto agudo del miocardio (IAM) en estudiantes de ciencias de la salud e identificar los cambios que ocurren en éstos al implementar el aprendizaje basado en problemas (ABP). Marco de referencia: las nuevas tendencias de enseñanza- aprendizaje en ciencias privilegian la construcción de actividades participativas que propicien el razonamiento científico, la argumentación y la apropiación de los conceptos específicos, dirigidos a la comprensión de la racionalidad de la ciencia y su aplicación en el contexto cotidiano. Diseño: estudio descriptivo con análisis comprensivo cualitativo en estudiantes de tercer semestre de pregrado de la Facultad de Salud de la Universidad Tecnológica de Pereira. Intervenciones: inicialmente se caracterizaron los modelos explicativos de los estudiantes acerca del concepto IAM, clasificándolos según cuatro categorías: sentido común (SC), anatómico/tisular (AT), celular/ funcional (CF), biológico/metabólico (BM). En el segundo momento se implementó el ABP como estrategia didáctica de intervención de los modelos explicativos. Luego se conformó un grupo focal con el cual se llevó a cabo un análisis comprensivo y en profundidad del cambio en los modelos explicativos. Resultados: en la primera fase del análisis se encontró que la mayoría de estudiantes se encontraba en el modelo SC, posteriormente, se nota una progresión a los modelos superiores, siendo el AT el más frecuente; finalmente, se logra identificar que los estudiantes demuestran tener elementos de varios modelos. Conclusiones: se logró evidenciar un cambio sustancial en los modelos explicativos iniciales; lo que permite vincular al ABP como estrategia didáctica para promover el cambio conceptual.

Abstract Objective: to characterize the explanatory models of acute myocardial infarction (AMI) in health sciences students and to identify the changes that occur in them when implementing problem-based learning (PBL). Frame of reference: the new teaching-learning trends in science benefit the construction of participatory activities that propitiate scientific reasoning, argumentation and the appropriation of specific concepts, aimed at understanding the rationality of science and its application in the everyday context. Design: descriptive study with comprehensive qualitative analysis in undergraduate third-semester students of the Faculty of Health of the Technological University of Pereira. Interventions: the students' explanatory models about the IAM concept were initially characterized, classifying them according to four categories: common sense (CS), anatomical / tissue (AT), cellular / functional (CF), biological / metabolic (BM). In the second time, the PBL was implemented as a didactic strategy for the intervention of explanatory models. Then a focus group was formed with which a comprehensive and in-depth analysis of the change in the explanatory models was carried out. Results: in the first phase of the analysis it was found that the majority of students were in the CS model; later, a progression to the higher models was observed, being the AT the most frequent. Finally, it is possible to identify that the students demonstrate having elements of several models. Conclusions: a substantial change in the initial explanatory models was evidenced, thus allowing to link the PBL as a didactic strategy to promote conceptual change.

Explanatory models for work and organizational phenomena: epistemological, theoretical, and methodological issues / Modelos explicativos de fenômenos em POT: aspectos epistemológicos, teóricos e metodológicos / Modelos explicativos de fenómenos en POT: aspectos epistemológicos, teóricos y metodológicos

This paper aims to discuss explanatory models in Work and Organizational Psychology by analyzing their metatheoretical underpinnings. In particular, the paper analyzes the concepts of causes and reasons, both of which perform a central role in the constitution of scientific models. We demonstrate that experimental, correlational, and case study explanatory models use causes and reasons as strategies of knowledge building, and as a means of linking phenomenon, data, and theory. We also discuss the methodological implications of such use of causes and reasons by scientific models. The paper concludes by discussing theoretical and methodological issues involved in the attempts at building complex models in WOP - showing that, in order to be complex, a model needs to include in its formulation stable-dynamic, cause-reason, and contextual distance-proximity analyses, as well as the theory-phenomenon-data triad.

Este artigo tem como objetivo discutir modelos explicativos em Psicologia Organizacional e do Trabalho tendo, como pano de fundo, uma análise das bases metateóricas que os sustentam epistemologicamente. Em particular, analisam-se os conceitos de causas e razões, ambos centrais na composição desses modelos. Demonstramos que os modelos explicativos experimentais, correlacionais e os estudos de caso utilizam-se distintamente de causas e razões em suas estratégias de construção do conhecimento e de articulação entre dados, fenômeno e teoria, e que essa utilização tem implicações no nível metodológico. Finaliza-se problematizando aspectos teórico-metodológicos envolvidos na construção de modelos mais complexos em POT, que levem em conta a análise das dimensões estáveldinâmico, causa-razão e distanciamento-proximidade do contexto, e a tríade teoria-fenômeno-dado.

Este artículo tiene como objetivo discutir modelos explicativos en Psicología Organizacional al y del Trabajo, teniendo como trasfondo un análisis de las bases metateóricas que los sostienen epistemológicamente. En concreto, se analizan los conceptos de causas y razones, ambos centrales en la formación de dichos modelos. Demostramos que tanto los modelos explicativos experimentales, como los correlacionales y los estudios de caso utilizan, indistintamente, causas y razones en sus estrategias de construcción del conocimiento y de articulación de datos, fenómenos y teoría, y que tal utilización tiene implicaciones en el nivel metodológico. Finalmente, se problematizan aspectos teóricometodológicos implicados en la construcción de modelos más complejos en POT, que tengan en cuenta el análisis de las dimensiones estable-dinámico, causa-razón, y distanciamiento-proximidad del contexto, así como la tríada teoría-fenómeno-dato.

Modelos explicativos de la dependencia y consumo de tabaco en estudiantes de preparatoria / An Explanatory Model of Tobacco Consumption among High School Students

El propósito principal del estudio fue explicar la dependencia tabáquica y el consumo de cigarros desde una perspectiva motivacional en una muestra de estudiantes de preparatoria de sexo indistinto. Se emplearon cuatro escalas del Inventario de Wisconsin de Motivos de Dependencia del Tabaco, una escala de normas paternas y una de amigos fumadores; así como dos medidas internacionales de consumo de cigarrillos y un cuestionario de dependencia tabáquica. El análisis de regresión múltiple de dependencia tabáquica mostró que exposición a claves, normas paternas y reforzamiento positivo explicaron el 54.30% de la varianza. Se elaboró un modelo estructural de la dependencia al tabaco que incluyó los motivos mencionados y el número de días de consumo, el cual se ajustó bien a los datos. Todos los efectos directos sobre las medidas de dependencia fueron significativos, así como las covarianzas entre los motivos. De acuerdo al estadístico Wald que se obtuvo en el análisis de clases latentes, hubo diferencias significativas entre los tres grupos en los cuatro indicadores: dependencia, exposición a claves, amigos fumadores y número de días de consumo.

The main purpose of the study was to explain tobacco dependence and consumption of cigarettes from a motivational perspective on a sample of high school students of both sexes. We used four scales of the Wisconsin Inventory of Smoking Dependence Motives, a scale of parental rules and a scale of smoking friends; as well as two international measures for cigarette consumption and a tobacco dependence questionnaire. The multiple regression analysis of tobacco dependence showed that the key exposure, parental rules and positive reinforcement, accounted for 54.30% of the variance. In this study, was developed a structural model of the tobacco dependence that included the four motives and the number of days of consumption, which fits well with the data; all direct effects on measures of dependency were significant, as the covariance among the motives. According to the Wald statistic obtained in the latent class analysis, there were significant differences among the three groups in the four indicators: dependency, exposure to key, smoking friends and number of days of consumption.

La perspectiva de género y la relación médico-paciente para el problema de la infertilidad / Gender perspective and the physician-patient relationship in treating infertility

Se hace una reflexión acerca de la necesidad de incluir la categoría género en la evaluación de la calidad de la atención a la infertilidad. El punto de partida que se plantea es la identificación de modelos explicativos personales para la infertilidad de hombres y mujeres, y prestadores(as) de salud, para lograr establecer diferencias y similitudes entre sus valoraciones. Se propone volver a pensar en la calidad de la atención desde una perspectiva de género, a partir de la identificación de zonas de encuentros y desencuentros entre los mundos valorativos de pacientes y prestadores de salud

This paper made a reflection on the need of including the category gender in the evaluation of the quality of care to infertility. The starting point is the identification of personal explanatory models for infertility in men and women, and health providers, with a view to seeing the differences and similarities among their assessments. It made the proposal of re-thinking the quality of care of infertility from a gender perspective, based on the identification of areas of agreement and disagreement between the evaluating worlds of patients and of health providers

<>. Modelos explicativos sobre la depresión y el malestar emocional entre los adolescentes barceloneses (España). Primera parte / <>. Explanatory models of depression and emotional distress among adolescents in Barcelona (Spain). Part one

Introduction In recent years, adolescent mental health has become a health policy priority in the majority of OCDE and European countries. According to the World Health Organization, in Europe some two million children and adolescents suffer from some type of mental disorder, especially depression, which affects 4% of the adolescents between the ages of 12 and 17, and 9% of 18-year-olds. As is also the case for behavioural and anxiety disorders, rates of adolescent depression are on the rise. Several studies associate depression in adolescence with either current or future consumption of psychoactive substances, a diagnosis of severe mental disorder in adulthood, and suicide. Some studies highlight the importance of social factors and lifestyles in the etiology and prognosis of these types of disorders; for example, various forms of social discrimination, abusive parents, and bullying. The incidence and prevalence of depression appear to be increasing among adolescents, as well as self-reported distress among young people and so-called «negative mood states¼. Despite the importance of depression, sadness, and so-called «negative mood states¼ among adolescents, there is a clear lack of qualitative studies analyzing these phenomena, and especially of studies that provide knowledge about the perceptions and cultural models of this age group with respect to their own sense of distress and lay strategies for coping with adversity, and the role of social capital as a buffer against it. Objective and methods The objective of this article is to describe the adolescents' explanatory models (EMs) or lay perceptions on depression, sadness, and related factors. With this purpose we performed an ethnographic study in a sample of 49 students (age 15-16) in three public secondary-schools of Barcelona and its metropolitan area using semi-structured interviews, cultural-domains interviews, and focus groups. We employed content analysis and semantic network analysis for qualitative data, and frequency analysis, cultural-consensus analysis, and multidimensional scaling for quantitative data. Results The results outline that adolescents use their own nosologies to define depressive mood states such as «rallado¼, «burchado¼, «chof¼, or «deprimido¼. These categories are dichotomically organized between passive items (i.e. to feel sadness or loneliness) and active items (i.e. <>). The state of deprimido (being depressed) is related to feelings of physical weariness and apathy. It can be defined as «a culmination of situations that make you feel bad¼, including the sense of feeling misunderstood by peers and adults, feeling insecure when having to take decisions or with his/her physical appearance, alone or isolated or in a bad mood. A person that is depressed is someone who «isn't in the mood to even speak about anything¼, that finds him/herself bad because «things haven't turned out as they expected¼. This leads him/ her «to blame him/herself for things¼, to have «very low self-esteem¼, to not «leave the house¼, to «become closed within himself¼, to «build a wall¼ or a «bubble¼, to think that «nothing is worth anything¼ and that «the whole world is against him/her¼. One can cope with that state for being a «bad time in a person's life¼, but it can also become «a burden that is much more¼ or «an eternity that never ends¼. When we asked our adolescents, «how can you tell that a person is sad or worried?¼, their answers were varied. One of the most common is to show an oscilation between the passive characteristics of discomfort and its active correlate, between isolation and an uneasy response, despite this behavior not being premeditated. A person that is rallada, deprimida or burchada can appear «isolated from society¼ and feel unaccepted, alone, insecure, apathetic; he/she might «stop talking or interacting with others¼, find him/herself feeling «tired of everything¼, downcast, depressive, as if he/she had experienced un bajón (suddenly feeling down); distracted, serious and without smiling, or anxious and nervous, and because of that hurting others although unintentionally. He/she can also sigh and weep, have difficulties to «express him/herself¼, appear to have «changed¼ for not behaving as he/she normally does, or have a lost gaze. The perception that adolescents have of a person exhibiting characteristics such as rallada, triste, burchada, or deprimida is not isomorphic with the vision they hold of themselves when they suffered adversity or experienced discomfort in the past. For example, the category rallada is not used very much in these cases, perhaps in order to save a semantic stigmatizing load. They normally define expressions of discomfort in terms such as «a desire to forget about school, of people and of everything¼, «scream where no one can hear you¼, «break things or hit someone¼, self-inflict physical pain «to balance the pain from within with exterior pain¼, «make someone feel the same as I feel¼, «flee or run very far¼, or of locking oneself up in one's bedroom to «cry while listening to music¼. They also feel powerless before «the things that they can not confront¼, «inferior to others¼, worthless, guilty, with difficulties to concentrate and insomnia. The adolescents situate the causes of their afflictions in the universe of their interactions with family members, adults in general, and peers, within situations of pressure and overexertion in daily life. When we segmented dates by gender we observed that male adolescents prioritized the «school loads¼ before «relations with friends¼, while female adolescents a higher relevance to these followed by «affective relations¼. When we asked our informants, «In your opinion, what can be done to help a person your age that is in this state of sadness or discomfort?¼, the answers were very diverse, but coincided as a whole to empower sociability between peers. It is striking although congruent with available literature that they discard the possibility of accompanying or referring the affected person to a specific professional for help or even suggest him/her to speak to his/her parents, tutors or professors. As a matter of fact, adolescents constitute an age group characterized by their vague consideration of professional resources in their help-seeking processes. Discussion A fundamental reason for the avoidance of professional services by adolescents is the existence of an explanatory model that, contrary to expert discourses from the «psy¼ field, understands afflictions as products of the social world. If the causes of discomfort are a result of social interactions (conflicts between equals, states of solitude and isolation, lack of recognition or prestige, dissonances with the models of the body and person, problems in the development of their autonomy against the tutelage of adults, etc.), the restitution of wellbeing must structure itself on those same relations and on that same independence in regards to the adult world. Our data points to a need to establish dialogical strategies of intervention. Insofar as adolescents show explanatory models different to the expert and adult systems in general, it is easy for them to feel indifferent to the interventions that do not involve them as active agents. They want to be protagonists of their own stories. For this reason, the promotion of participation and the dialogue of information (expert and lay) are guidelines that, in our opinion, must be present in any intervention in this field. In these strategies we find the possibility of reconverting lay explanatory models and social capital in a fundamental axis of mental health programs for adolescents.

Introducción En los últimos años, la salud mental de los adolescentes se ha convertido en una prioridad de las políticas sanitarias en la mayoría de los países de la OCDE y, especialmente, en Europa. La razón está justificada. Según la OMS, se calcula que dos millones de menores y jóvenes europeos sufren algún tipo de trastorno mental, entre los que destaca la depresión que afecta 4% de los adolescentes de entre 12 y 17 años y 9% de los jóvenes de 18 años. Junto con los trastornos de ansiedad y de conducta, ello dibuja una tendencia a la alza. A pesar de la relevancia de la depresión, la tristeza y los denominados «estados de ánimo negativos¼ entre los y las adolescentes, existe un claro déficit de investigaciones cualitativas que analicen estos fenómenos, principalmente si hablamos de investigaciones que permitan conocer las percepciones y modelos culturales de este grupo de edad con respecto a su propio malestar, así como sobre sus estrategias profanas para afrontar la adversidad y el papel de su capital social. Esta ausencia de investigaciones entra en contradicción con la importancia que estas variables adquieren en la salud mental y la salud pública contemporáneas. Objetivo y métodos El objetivo de este artículo es analizar los modelos explicativos o percepciones profanas de los adolescentes sobre la depresión, la tristeza y sus factores asociados. Con este propósito se realizó un estudio etnográfico en una muestra de 49 estudiantes (de edad entre 15 y 16 años) en tres centros públicos de enseñanza secundaria de Barcelona y su área metropolitana mediante entrevistas semiestructuradas, entrevistas de dominios culturales y grupos focales. Se empleó el análisis de contenido y de redes semánticas para los datos cualitativos obtenidos y el análisis de frecuencia, de consenso cultural y el escalado multidimensional para los datos cuantitativos. Resultados Los adolescentes utilizan sus propias nosologías para definir sus estados de ánimo como «rallado¼, «burchado¼, «chof¼ o «deprimido¼. Estas categorías se organizan entre un polo pasivo (sentirse triste o solo, por ejemplo) y otro activo (i.e., «estar enfadado¼). Las expresiones del malestar depresivo son detectadas entre los iguales por la gestualidad (i.e., «el rostro¼, «la mirada¼) y el comportamiento (i.e., aislamiento social), pero sólo de forma marginal por el bajo rendimiento académico. Las causas de la depresión se vinculan con los conflictos en las relaciones interpersonales con iguales y adultos. No obstante, el proceso de búsqueda de salud o ayuda más común implica a los iguales, ya que los adultos son percibidos únicamente como un recurso para situaciones de gravedad inusual. De hecho, los adolescentes constituyen un grupo de edad caracterizado por considerar vagamente los recursos profesionalizados en sus procesos de búsqueda de ayuda. Discusión Una razón fundamental de la evitación de los servicios profesionales de atención por parte de los adolescentes barceloneses es la existencia de un modelo explicativo que, a diferencia de los discursos expertos en el campo «psi¼, entiende las aflicciones como productos del mundo social. Si las causas del malestar derivan de las interacciones sociales, la restitución del bienestar debe conformarse a partir de estas mismas relaciones y también de esta misma independencia con respecto al mundo adulto. Si bien los resultados de nuestra investigación no son extrapolables a la población adolescente catalana en general, éstos indican la necesidad de establecer estrategias dialógicas de intervención que permitan reconvertir los modelos explicativos legos y el capital social de los adolescentes en un eje fundamental de los programas en salud mental.