Aspectos psicológicos de la rehabilitación pulmonar en el paciente con enfermedad pulmonar obstructiva crónica / Psychological aspects of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

We present a review of the literature available on the psychological issues of the rehabilitation of patients with chronic obstructive pulmonary disease (COPD). The review is organized around four main themes. First, we present the more commonly psychological manifestations described among patients with COPD, in particular depression and anxiety. Second, we discuss some psychosocial factors that may influence the treatment and course of the disease, including the following: social support, illness beliefs, self-efficacy and self- management (human agency). Third, we present treatments and interventions that are considered to be effective for the management of these psychological disorders in patients with COPD and discuss the evidence. The chapter ends with a discussion about the influence of the pulmonary rehabilitation on the psychological and psychiatric symptoms that these patients present.

Se realiza una revisión de la literatura sobre los aspectos psicológicos de la rehabilitación pulmonar en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). La revisión está organizada en cuatro temas centrales. Primero, se presentan las manifestaciones psicológicas más habituales descritas en pacientes con EPOC, en particular trastornos depresivos y ansiosos. Segundo, se discuten algunos factores psicosociales que pueden influir en el tratamiento y curso de la enfermedad, incluyendo las siguientes: apoyo social, creencias de enfermedad, autoeficacia y autogestión en salud. Tercero, se presentan los tratamientos y las intervenciones que se consideran son más efectivas para el manejo de estos trastornos psicológicos en pacientes con EPOC y se discute su evidencia. El capítulo termina con una discusión sobre la influencia de la rehabilitación pulmonar en la sintomatología psicológica y psiquiátrica de estos pacientes.

Trastornos psiquiátricos y cognitivos de la hepatitis C y su tratamiento con interferón / Psychiatric and cognitive problems associated to hepatitis C and its treatment with interferon

This article is a literature search about the psychopathology related to hepatitis C and its treatment with interferon. An overview of the methodology of the available studies is presented. New theories for a better understanding and diagnosis of the psychiatric alteration associated to hepatitis C or interferon treatment are proposed, to improve future research. We discuss neurobiological aspects, clinical manifestations, psychosocial features and pharmacotherapy of the psychiatric manifestations of hepatitis C and its treatment with interferon.

Relación estudiante de medicina-enfermo: visión de los estudiantes / Medical student - patient relationschip: the students' perspective

Background: The relationship between medical students and patients has special characteristics that require to be well understood to prepare both students and tutors. Aim: To learn about medical students' thoughts and experiences once they start working with patients, how do they solve difficulties or problems and their perceptions about professional roles and patient rights. Material and methods: Qualitative study based on semi-structured interviews applied to 30 volunteer third year medical students who were beginning their clinical practice. The answers to open questions were transcribed and then analized and grouped by topics and categories. Results: Helping others was the main motivation to go to medical school. Other reasons were scientific interest and social status. Students felt prepared to communicate with patients. However they felt anxious, stressful and fearful of not being competent or not being able to answer patients' questions. There were some differences between male and female students' feelings. Nevertheless students declared that they had rewarding experiences with patients. They all recognized that patients have the right to reject being treated by students. The answers also showed that the first clinical experiences led to significant changes in their views of the medical profession. Conclusions: Students are aware of their trainee condition, the benefits that they obtain being in contact with patients and of their limitations. Patients must voluntarily accept to be subject of the students' training program and informed consent procedures need to be developed.