Necrotizing fasciitis in a patient with Chiari malformation Type II - A family case analysis / The Health Sciences Journal

@#The biopsychosocial approach to healthcare is fundamental to Family and Community Medicine specialists. Using the patient-centered, family-focused, community-oriented (PFC) matrix, the interplay of a myriad of biomedical and psychosocial factors is assessed in order to provide a thorough medical management that is custom-made to meet the needs and inherent values of a patient and his/her family. Family assessment tools are also utilized to better understand the family dynamics of a patient that may impact on the prescribed management plan. In addition, social determinants of health are evaluated to ascertain which ones may facilitate or hamper proper utilization of community resources. This family case analysis documented the medical ordeal of a young professional who had been diagnosed with two rare medical conditions: necrotizing fasciitis and Chiari malformation Type II. Employing the PFC matrix, the Family and Community Medicine specialist was able to provide inter-disciplinary care for the patient and his family in a holistic manner by recognizing patient needs, creating an enabling family support environment, and helping the family unit navigate various community resources.

Left out - persistent pediatric depression in Panhypopituitarism: A case report

@#This is a case of a 15-year-old Filipino male with a history of craniopharyngioma who underwent trans-sphenoidal surgery with panhypopituitarism as its sequelae. The biological factors of the patient's disease contributed to his persistent depression and were perpetuated by psychosocial and cognitive factors. A biopsychosocial approach was used in understanding this case to arrive at individualized treatment and management.

The Patient-centered, Family-focused and Communityoriented (PFC) Matrix: A toolkit for biopsychosocial approach in primary care

@#Biopsychosocial (BPS) approach to care is essential in family practice. Teaching this approach in family medicine is usually highlighted in family case presentations and counseling sessions. Little is done in showing how the biopsychosocial approach can be used in the day to day family practice. This article discusses the development of a learning tool called the PFC matrix which is a patient-centered, family-focused and community-oriented approach to care for individual patients and their families. The patient-centered care utilizes understanding of the interplay of biomedical psychosocial factors disease in order to implement management that is tailor-fitted to the needs and values of the patient. The family-focused component of the matrix utilizes family assessment to generate assumptions on how the family dynamics affect or facilitate the prescribed management of the patient’s disease. Lastly, the community-oriented component enables the family physician to use social determinants of health and health systems as a lens to understand how larger systems support or hinder the provision of care. Through the use of this matrix, the family physician is able to manage the patient in a holistic manner by recognizing patient needs, creating an enabling family support environment and helping the patient and family navigate various community resources. This results not only in optimal health for the patient but impacts to create a more responsive health system. In the future, further documentation of the use of the PFC matrix particularly in primary care in the light of universal health care and how it impacts on outcomes and how it connects patients and families at the correct tiers of the health system.

Psicosis, Discapacidad intelectual y trastornos conductuales: enfoque biopsicosocial / Psychosis, intellectual disability and behavioral disorders: biopsychosocial approach

Caso Clínico: Mujer, 23 años. Discapacidad intelectual. Asiste a colegio especial (no lee ni escribe). Institucionalizada. Motivo de ingreso: Paciente ingresa en octubre del 2017 traída por carabineros por ser encontrada en la calle bajo el efecto de múltiples sustancias, con ideación suicida. Días antes fue expulsada del hogar por agresión a cuidadoras. Diagnósticos de ingreso: Discapacidad intelectual moderado. Síndrome suicidal, Trastorno por dependencia a drogas. ¿Esquizofrenia hebefrénica? Evolución: Mantiene desajustes conductuales severos fluctuantes, con serias dificultades para manejar la rabia, lo que la lleva a tener conductas hetero y autoagresivas. Plan de tratamiento: Farmacológico (clozapina), Psicológico (TCC), Social (dispositivo adecuado post-alta). Clozapina para trastornos psicóticos en adultos con discapacidad intelectual. El principal riesgo de atribuir alguno de estos comportamientos a una supuesta "psicosis", es el de "medicalizar" y tratar de forma poco acertada. Es importante descartar factores ambientales y del aprendizaje (hábitos y conductas aprendidas, institucionalización, reacciones ante el estrés agudo.) La prevalencia de abuso y dependencia de sustancias en población con DI va desde el 0,5% al 2,6%. Lo cual es menor que la población general. Pacientes con DI y dependencia a drogas se asocia a otras enfermedades psiquiátricas (42-54%). Se ha informado que las personas con discapacidad intelectual en América Latina a menudo están institucionalizadas y escondidas de la sociedad en instalaciones deficientes y superpobladas.

Clinical Case: Female, 23 years old. Intellectual disability. He attends a special school (she does not read or write). Institutionalized. Reason for admission: Patient enters in October 2017 brought by police officers to be found in the street under the effect of multiple substances, with suicidal ideation. Days before she was expelled from the home because of assaulting caregivers. Admission diagnoses: Moderate intellectual disability. Suicidal syndrome, Disorder due to drug dependence. Hebephrenic schizophrenia? Evolution: Maintains fluctuating severe behavioral imbalances, with serious difficulties in managing rage, which leads to hetero and self-aggressive behaviors. Treatment plan: pharmacological (clozapine), Psychological (CBT), Social (adequate post-hospitalization discharge device). Clozapine for psychotic disorders in adults with intellectual disabilities. The main risk of attributing some of these behaviors to a supposed "psychosis" is that of "medicalizing" and dealing inappropriately. It is important to rule out environmental and learning factors (habits and behaviors learned, institutionalization, reactions to acute stress. The prevalence of substance abuse and dependence in the population with ID ranges from 0.5% to 2.6%. Which is less than the general population. Patients with ID and drug dependence are associated with other psychiatric illnesses (42-54%). It is reported that people with intellectual disabilty in Latin America are often institutionalized and hidden from society in poor and overcrowded facilities.

La Medicina General Integral una especialidad clínica con un verdadero enfoque biopsicosocial de la salud de la población / General Integral Medicine, a clinical specialty with a real biopsychosocial approach to the population´s health

Introducción: a partir del año 1984 se desarrolla en Cuba el Programa del Médico y Enfermera de la Familia, a partir del cual surge la especialidad de Medicina General Integral como especialidad efectora de la Atención Primaria de Salud, lo que ha propiciado el desarrollo de un potencial científico para el abordaje integral de la salud de la población. Objetivo: reflexionar sobre los antecedentes de la especialidad de Medicina General Integral en Cuba, a partir de una revisión bibliográfica y la experiencia en la práctica de los autores. Desarrollo: el especialista en Medicina General Integral caracteriza de manera detallada y particular a la población que atiende, identifica sus problemas de salud y establece una estrecha relación no solo médico-paciente, sino también médico-familia y médico-comunidad. Considera a los individuos de una manera integral, pertenecientes a una familia e insertados en una comunidad. Conclusiones: la Medicina General Integral como disciplina científica, determina la adquisición de las competencias necesarias para la solución de problemas sociales de nuestra población...

Introduction: since 1984, the Program of the Family Physician and Nurse emerged in Cuba and gave rise to the General Integral Medicine specialty as performing specialty of the primary health care. The aforementioned has encouraged the development of the scientific potential to comprehensively approach the population´s health.Objective: to thoroughly think about the antecedents of this specialty in Cuba from a literature review and the practical experiences of the authors.Discussion: the General Integral Medicine specialist characterizes in detail the population that he/she cares of, identifies their health problems and establishes a close relationship with the patient, the families and the community. He/she regards the individuals in a comprehensive way, as part of a family and inserted into the community.Conclusions: general Integral Medicine as a scientific discipline determines the learning of necessary competencies to solve social problems of our population...