Relajación muscular y depresión en pacientes con esclerosis múltiple: estudio de caso múltiple / Muscular relaxation and depression among patients diagnosed with multiple sclerosis: a multiple-case study

El objetivo de esta investigación fue medir el efecto del Entrenamiento en Relajamiento Muscular Progresivo de Edmund Jacobson en los niveles de Depresión de tres pacientes con Esclerosis Múltiple (EM). Participaron inicialmente y de forma voluntaria 8 sujetos, todos del género femenino, de clase media, quienes no contaban con ningún tipo prestaciones en salud. De dichos casos valorados, se eligieron a tres pacientes con diferentes niveles de depresión: primer caso (sin depresión), segundo caso (depresión leve) y tercer caso (depresión moderada). Ya que sólo se encontraron estos niveles de depresión en el grupo valorado, es decir no se encontró depresión grave, lo anterior de acuerdo con los resultados arrojados por el Inventario de Depresión de Beck. El trabajo se basa en un diseño de estudio de caso múltiple, donde cada caso debe ser tratado en forma individual para luego sacar conclusiones del cruce de dichos casos. Con resultados alentadores, ya que en las tres situaciones hubo mejoras, demostrando que dicho entrenamiento de relajación muscular tiene efectos positivos sobre los niveles de ansiedad de este tipo de pacientes. Además, en cuanto al análisis introspectivo de cada paciente reportaron mejoras no sólo en depresión, sino, en autoestima, comunicación, socialización, aprendizaje y aceptación de la enfermedad.

The purpose of this research was to measure what the effect of a Progressive Muscular Relaxation Training of Edmund Jacobson (Year) would have on the different depression levels of 3 multiple sclerosis (MS) patients. Participants included 8 middle-class females, who did not have any type of health care. From those 8 participants, only 3 were selected that showed a different level of depression: first participant (No depression), second participant (low depression), and third participant (moderate depression). Since only these types of different levels of depression were found among the participants, severe depression was not found, though according to Beck's Depression Questionnaire (Year). This is a multiple-case study type of research, where each participant was treated individually, to better understand in an in depth manner the connection of these cases. We can say that our results are promising, since all three participants showed improvements, indicating a positive effect with the Progressive Muscular Relaxation Training over anxiety levels of participants. As well, according to an introspective analysis of each participant were shown improvements not only in depression levels but in self-esteem, socialization, communication skills, learning and adaptability to their disease.

Guided imagery relaxation therapy on preoperative anxiety: a randomized clinical trial / Terapia de relaxamento com imagem guiada sobre a ansiedade pré-operatória: ensaio clínico randomizado / Terapia de relajación con imagen guiada en relación a la ansiedad preoperatoria: ensayo clínico aleatorizado

Objective to evaluate the effect of relaxation therapy with guided imagery on state anxiety and cortisol in the immediate preoperative period in patients submitted to bariatric surgery by videolaparoscopy. Method a randomized, triple-blind clinical trial in a large teaching hospital in the interior of Minas Gerais. Twenty-four patients who would undergo video-laparoscopic bariatric surgery were randomly allocated in two groups, namely 12 in the control group and 12 in the experimental group. State anxiety was assessed by the State-Trait Anxiety Inventory, and blood cortisol levels were measured before and after the intervention or standard care. Descriptive analyzes were used for the quantitative variables and Student's t-test for independent samples, in the analysis of the differences between the state anxiety scores and cortisol levels. Results the experimental group presented a statistically significant reduction of the state anxiety scores (p = 0.005) as well as of cortisol levels (p <0.001) after the intervention. Conclusion guided imagery relaxation therapy is an effective nursing intervention for the reduction of state anxiety and blood cortisol levels in the preoperative period in patients undergoing video-laparoscopic bariatric surgery. Brazilian Registry of Clinical Trials: RBR-5qywrf.

Objetivo avaliar o efeito da terapia de relaxamento com imagem guiada sobre a ansiedade-estado e o cortisol no pré-operatório imediato, em pacientes submetidos à cirurgia bariátrica por videolaparoscopia. Método ensaio clínico randomizado, triplo-cego, realizado em um hospital de ensino de grande porte, no interior de Minas Gerais. Foram alocados aleatoriamente 24 pacientes que foram submetidos à cirurgia bariátrica por videolaparoscopia (12 no grupo controle e 12 no grupo experimental). A ansiedade-estado foi avaliada pelo Inventário de Ansiedade Traço-Estado, e os níveis de cortisol sanguíneo foram dosados, antes e após a aplicação da intervenção ou cuidados-padrão. Análises descritivas foram usadas para as variáveis quantitativas e teste t de Student para amostras independentes, na análise das diferenças entre os escores de ansiedade-estado e níveis de cortisol. Resultados o grupo experimental apresentou redução estatisticamente significativa dos escores de ansiedade-estado (p=0,005), bem como dos níveis de cortisol (p<0,001), após a intervenção. Conclusão a terapia de relaxamento com imagem guiada apresenta-se como uma intervenção de enfermagem eficaz para a redução da ansiedade-estado e níveis de cortisol sanguíneo, no período pré-operatório, em pacientes submetidos à cirurgia bariátrica por videolaparoscopia. Registro Brasileiro de Ensaio Clinico: RBR-5qywrf.

Objetivo evaluar el efecto de la terapia de relajación con imagen guiada sobre la ansiedad-estado y el cortisol en el preoperatorio inmediato en pacientes sometidos a cirugía bariátrica por videolaparoscopia. Método ensayo clínico aleatorizado, triple-ciego, realizado en un hospital de enseñanza de gran porte, en el interior de Minas Gerais. Se asignaron al azar 24 pacientes para ser sometidos a la cirugía bariátrica por videolaparoscopia (12 en el grupo control y 12 en el grupo experimental). La ansiedad como estado fue evaluada por el Inventario de Ansiedad Rasgo y Estado, y los niveles de cortisol sanguíneo fueron dosificados, antes y después de la aplicación de la intervención del cuidado estándar. Los análisis descriptivos se utilizaron para las variables cuantitativas y la prueba t de Student para muestras independientes, en el análisis de las diferencias entre los escores de ansiedad como estado y los niveles de cortisol. Resultados el grupo experimental presentó una reducción estadísticamente significativa de las puntuaciones de ansiedad como estado (p = 0,005), así como de los niveles de cortisol (p <0,001), después de la intervención. Conclusión la terapia de relajación con imagen guiada se presenta como una intervención de enfermería eficaz para la reducción de la ansiedad como estado y niveles de cortisol sanguíneo, en el período preoperatorio en pacientes sometidos a la cirugía bariátrica por videolaparoscopia. Registro Brasileño de Ensayo Clínico: RBR-5qywrf.

Perioperative Psychological and Music Interventions in Elderly Patients Undergoing Spinal Anesthesia: Effect on Anxiety, Heart Rate Variability, and Postoperative Pain

PURPOSE: The aim of this study was to evaluate the effects of perioperative psychological and music interventions in elderly patients undergoing elective surgery on anxiety, post-operative pain, and changes in heart rate variability (HRV) to ascertain if perioperative psychological and music interventions can affect overall anxiety levels. MATERIALS AND METHODS: Fourty elderly patients undergoing elective surgery were randomized to two groups; one group received psychological and music intervention, and the other was the control. The intervention group underwent psychological intervention and listening to music for 30 min before surgery. RESULTS: The mean change in HRV as determined by low frequency (LF) power measurements. After the intervention, the ratio of mean LF to high frequency (HF) power decreased significantly in the intervention group compared to before the intervention (p<0.05). In the control group, mean LF measurements and the ratio of LF:HF did not change significantly. In the intervention group, mean HF power was significantly higher after the procedure than before (p<0.01). Moreover, the mean self-rating anxiety score of the intervention group decreased after the procedure compared to before (p<0.05). The mean visual analogue score of the intervention group 6 hours after surgery was significantly lower than that of the control group (p<0.01). CONCLUSION: Perioperative psychological and music interventions can reduce anxiety and postoperative pain in elderly patients.

Influencia del estrés en la eficacia del tratamiento en pacientes con trastornos temporomandibulares / Stress influence in efficacy of treatment in patients with temporomandibular disorders

El efecto del estrés emocional en el dolor, el sufrimiento y la conducta de dolor es significativo y debe tenerse en cuenta cuando se evalúa o se trata cualquier trastorno doloroso. El estado emocional del paciente en gran medida depende del estrés psicológico que experimente, y el momento en que se inicia el dolor puede influir enormemente en la experiencia dolorosa. El estudio fue de tipo cuasiexperimental, se consideraron 80 pacientes que fueron diagnosticados con trastornos temporomandibulares. A los pacientes participantes en el estudio les fue aplicada una escala sintomática del estrés y terapia combinada para la reducción del dolor y relajación muscular que incluyó terapia oclusal, farmacológica, sustitutiva y técnicas de autorrelajación, arribando a las conclusiones que un elevado por ciento de los pacientes refirieron síntomas de estrés que se estima puede afectar negativamente los resultados del tratamiento en pacientes con trastorno temporomandibular(AU)

Emotional stress effect on pain, suffering and pain behavior is significant and we must to consider in assessment or treatment of any painful disorder. The emotional status of patient in large extent depends of psychological stress experimented and the moment when the pain starts may influence extremately in painful experience. A quasi-experimental study was conducted considering 80 patients diagnosed with temporomandibular disorders. In study participating patients we applied a stress symptomatic scale and combined therapy to reduce pain and the muscular relaxation included occlusal, pharmacologic, substitute therapy and self-relaxation techniques, concluding that a high percentage of patient refered to stress symptoms considered that may to affect negatively the treatment results in patients with temporomandibular disorders(AU)

Effects of progressive muscular relaxation training on quality of life in anxious patients after coronary artery bypass graft surgery.

Background & objectives: Evidences suggest that relaxation therapy may improve psychological outcomes in heart patients. We evaluated the effect of progressive muscular relaxation (PMR) training in decreasing anxiety and improving quality of life among anxious patients after coronary artery bypass graft surgery (CABG). Method: This study was an open uncontrolled trial. The sample included 110 anxious patients referred to the cardiac rehabilitation clinic of Tehran Heart Center, Tehran, Iran, during six weeks after coronary artery bypass graft (CABG). Patients were allocated to receive both exercise training and lifestyle education plus relaxation therapy (relaxation group; n=55) or only exercise training beside lifestyle education (control group or the recipient of usual care group; n=55). Duration of the relaxation therapy was 6 wk and in the case of usual care was 8 wk. Both the groups were followed up one month after completion of intervention. Anxiety and quality of life in the two treatment groups were compared. Results: There were no signifi cant differences in overall QOL, state anxiety and trait anxiety scores between the two groups before intervention. Signifififi cant reductions in state anxiety (P<0.01) and trait anxiety (P<0.01) levels were observed in relaxation group after intervention compared to control group. Women had high state anxiety and a low quality of life than men in the two groups before intervention. After intervention, there was no difference between men and women in the relaxation group. Interpretation & conclusions: Our fi ndings show that progressive muscular relaxation training may be an effective therapy for improving psychological health and quality of life in anxious heart patients.