RESUMO
Background: Preliminary evidence suggests that psychological trauma, especially childhood trauma, is a risk factor for the onset of fibromyalgia (FM). Objective: The main objective of this study consisted of evaluating the prevalence and detailed characteristics of psychological trauma in a sample of patients with FM, the chronology of trauma across the lifespan, and its clinical symptoms. We also calculated whether childhood trauma could predict the relationship with different clinical variables. Method: Eighty-eight females underwent an interview to assess sociodemographic data, psychiatric comorbidities, level of pain, FM impact, clinical symptoms of anxiety, depression, insomnia, quality of life, and psychological trauma. Results: The majority of participants (71.5%) met the diagnostic criteria for current post-traumatic stress disorder (PTSD). Participants reported having suffered traumatic events throughout their lifespan, especially in childhood and early adolescence, in the form of emotional abuse, emotional neglect, sexual abuse, and physical abuse. Traumatic events predict both poor quality of life and a level of pain in adulthood. All patients showed clinically relevant levels of anxiety, depression, insomnia, suicidal thoughts, and pain, as well as somatic comorbidities and poor quality of life. Pain levels predicted anxiety, depression, dissociation, and insomnia symptoms. 84% of the sample suffered one or more traumatic events prior to the onset of pain. Conclusions: Our data highlight the clinical complexity of patients with FM and the role of childhood trauma in the onset and maintenance of FM, as well as the high comorbidity between anxiety, depression, somatic symptoms, and FM. Our data also supports FM patients experiencing further retraumatization as they age, with an extremely high prevalence of current PTSD in our sample. These findings underscore the need for multidisciplinary programs for FM patients to address their physical pain and their psychiatric and somatic conditions, pay special attention to the assessment of psychological trauma, and provide trauma-focused interventions. Trial registration: ClinicalTrials.gov NCT04476316. Registered on July 20th, 2020.
Assuntos
Fibromialgia , Trauma Psicológico , Adulto , Feminino , Humanos , Estudos Transversais , Fibromialgia/epidemiologia , Dor/epidemiologia , Dor/etiologia , Trauma Psicológico/epidemiologia , Qualidade de VidaRESUMO
INTRODUCTION: Violence against women (VaW) directly influences their quality of life and mental health. Unfortunately, its influence may be ignored or underestimated by professionals attending these women. OBJECTIVES: To describe a hospitalized sample of women suffering from emergent VaW who visited the mental health department for other reasons. To evaluate the degree of knowledge about VaW and interventions for VaW taken by health professionals. METHODS: We performed an observational, prospective study with systematic data collection on all cases of emergent and/or urgent VaW at the Corporació Sanitària Parc Taulí (Sabadell, Spain) from January-December 2004 and January-December 2006. The reference population consisted of 390,000 inhabitants, mostly urban and from the industrial and service economic sectors. A descriptive statistical analysis was performed. RESULTS: In the two study periods, 218 and 194 women, respectively, were attended for emergent and/or urgent VaW resulting in severe injures and/or medical and/or social assistance. Of these, up to 53 received or had received specialized mental health treatment. Most of these women (69.7%) withdrew from follow-up. We detected a high rate of comorbid abuse or dependence on alcohol (27.3%), benzodiazepines (33.3%) or other drugs of abuse and a high rate of suicide attempts (41.9%) and successful suicides in these periods. VaW was explicitly registered in only 51.1% of the cases and a specific intervention for VaW was documented in only 15.2% of the cases. CONCLUSIONS: The prevalence of psychiatric and/or psychological disorders was very high in our sample, but the presence of VaW was not always specifically documented or treated.
RESUMO
La falta de adherencia terapéutica es un problema común en la práxis médica. En la esquizofrenia y otros trastornos psicóticos es la mayor causa de recaídas. Las cifras de incumplimiento en la psicosis oscilan entre el 40 por ciento y el 80 por ciento. El problema es atribuible a distintos factores que se comentaran a lo largo del artículo. De entre los motivos que influyen en la decisión de abandonar los tratamientos médicos cabe destacar: información insuficiente facilitada a los enfermos, una alianza terapéutica pobre entre médico y paciente, o la falta de comprensión de la propia enfermedad. Con el fin de aumentar la adherencia terapéutica se han diseñado distintos programas psicoterapéuticos. Entre ellos, el módulo de la medicación y su control, desarrollado por el equipo del prof. R.P. Liberman de la UCLA, pretende paliar el problema del incumplimiento con un programa para pacientes esquizofrénicos en el que se persiguen dos objetivos: a) informar a los pacientes sobre la medicación y b) incentivar la participación activa en el tratamiento. Este tipo de intervenciones psicosociales consiguen aumentar la adherencia aproximadamente un 30 por ciento. (AU)
